The guidelines, issued by the American Heart Association/American Stroke Association, are published in the association's journal Stroke.
In a video posted on the association's website, Dr. Biller explains two of the most important points of the guidelines:
- More stroke patients now will be able to benefit from a clot-busting drug called alteplase, when administered during the first 4½ hours of the onset of a stroke.
- In certain patients, mechanically removing blood clots to restore blood flow in the brain can be effective for up to 24 hours after the stroke's onset. In previous guidelines, the treatment window was six hours.
Dr. Biller, chair of Loyola's department of neurology, is an internationally known expert on stroke care.
The new guidelines are titled, "2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." The guidelines writing group was chaired by neurologist William J. Powers, MD, of the University of North Carolina in Chapel Hill.
The guidelines apply to ischemic strokes, which account for about 85 percent of all strokes. An ischemic stroke typically is caused by a blood clot that blocks blood flow to a region of the brain. Without blood supply, brain cells begin to die. Timely treatment to remove the clot and restore blood flow can minimize stroke damage.
One treatment involves intravenous administration of alteplase (also known as tPA), which can dissolve clots. The new guidelines broaden treatment criteria to include select patients with mild strokes, who previously were not eligible for this treatment. Doctors should weigh the risks and benefits in individual patients.
A second treatment is a procedure called mechanical thrombectomy that physically removes the clot. The physician inserts a catheter in the patient's groin and guides the thin tube through various blood vessels up to the brain. Once the catheter reaches the blockage, the physician deploys a device through the catheter that removes the clot, either by grabbing and pulling it out or suctioning it out.
Mechanical thrombectomy is indicated for clots blocking large blood vessels. The new guidelines say the procedure can be done as long as 16 hours after a stroke in selected patients. Under certain conditions, based on advanced brain imaging, the time window can be extended to 24 hours.
The guidelines also recommend "telestroke" programs for hospitals that don't have access to neurologists or emergency room doctors trained to use the clot-busting drug. Such programs use real-time videoconferencing to connect hospitals to stroke experts. Research shows that telestroke patients receive the same quality of care as if they were treated at a stroke center with a neurologist on call.
Loyola Medicine operates a growing telestroke network that serves 10 centers in Illinois, Indiana and Iowa. Loyola stroke specialists are on call 24/7 to examine patients remotely and recommend treatments to physicians at the bedside.
One critical guideline has not changed: The recommendation for fast action when a person first shows stroke symptoms.
"Time is brain," Dr. Biller said. "In the right patient, treatment with a clot-busting drug or mechanical thrombectomy has the potential to significantly limit stroke damage. Every effort should be made to treat these patients as early as possible with a multidisciplinary and integrated team of experts."
A simple way to remember the signs of a stroke is to think of the word FAST:
F – Face drooping: Does one side of the face droop or is it numb? Ask the person to smile. A – Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? S – Speech difficulty: Is speech slurred, are they unable to speak or are they hard to understand? T – Time to call 911. If the person shows any if these symptoms, even if the symptoms go away, call 911 and bring them to the hospital immediately.
Loyola's Stroke Center includes a nationally recognized team of experts in every facet of stroke-related care, including neurology, neurosurgery, neuroradiology, emergency medicine, rehabilitative services, social work, pharmacy and specialized neuroscience nursing. Loyola is among an elite group of hospitals nationwide to be certified by The Joint Commission as a comprehensive stroke center.
For nine years in a row, Loyola has received the American Heart Association/American Stroke Association's Get With The Guidelines® - Stroke Gold Plus Quality Achievement Award. The award recognizes Loyola's commitment to providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.
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