September 24th, 2018

What’s Up Doc?: New stroke management guidelines can benefit many more patients

By Medicine Hat News on March 6, 2018.

Every nine minutes someone in Canada has a stroke. In the U.S., it happens once every minute. Usually the prognosis is not good.

But the odds of survival are getting better because of a new emergency intervention being offered at many hospitals across Canada and the U.S.

While the majority of strokes strikepeople over the age of 65, 10 to 15 per cent affect individuals 45 and younger. What is alarming is this number is on the rise.

Stroke is the second-leading cause of death in the world and a leading cause of adult disability.

According to the Heart and Stroke Foundation of Canada’s2014 annual report, strokes in people in their 50s have increased 24 per cent over the last decade.

That is the bad news. The good news isHeart and Stroke Foundation is making changes in itsstroke treatment guidelines, extending the window for endovascularthrombectomyfrom six hours to 24 hours.

Endovascular thrombectomy is the emergency procedure to remove the damaging blood clots from the blood vessel that is blocking the blood flow to the vital parts of the brain.

The change in the management of acute stroke comes after both the Heart and Stroke Foundation in Canada and the American Heart Association reviewed research suggesting it’s possible for some patients to benefit from the procedure even after many hours have passed since their first symptoms of stroke.

All patients may not be eligible for treatment if they are seen after six hours. But it is expected some patients may be eligible for treatment within six to 24-hour window.

Patients living in remote areas or who suffer a stroke in their sleep expected to benefit most from the new 24-hour guidelines.

Removing blood clots: Mechanical thrombectomy (endovascularthrombectomy)is a procedure where doctors remove blood clots using a device passed through a blood vessel. New research shows some carefully selected patients may benefit having this procedure even after the six-hour window has passed (up to 24-hours). Up to 20 per cent of all ischemic stroke patients are currently eligible for clot removal. This number is expected to increase.

Dissolving blood clots: In the second method doctors use clot-dissolving intravenous medication called alteplase (tPA). Alteplase was approved to treat ischemic stroke about 20 years ago and remains the only medication approved by the FDA to dissolve clots. It has been proven to decrease disability when given promptly (within six hours of onset of symptoms).

These two procedures can only be used for ischemic strokes (strokes caused by a blood clot), as opposed to those caused by a bleed in the brain.

Recognizing signs of stroke: Studies have shown one in seven young patients were given a misdiagnosis of vertigo, migraine, alcohol intoxication, seizure, inner ear disorder or other problems – and sent home without proper treatment.

Age of the patient does not matter. If they have the FAST signs, whether they resolved or not, it was probably a stroke. Call 911 right away. Remember the acronym FAST:

Face:Is it drooping?

Arms: Can you raise both?

Speech: Is it slurred or jumbled?

Time: To call 911 right away.

Dr. Bharwani is a general surgeon, freelance writer, photographer and author of A Doctor’s Journey and Doctor B’s Eight Steps to Wellness. His latest book is available at Shoppers Drug Mart and Coles Book Store (Medicine Hat Mall), and You can discuss this article and other articles on his website: and sign up for RSS feed, Twitter or get on the email list.

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