Medical advances making for dramatically improved stroke outcomes
Heart & Stroke’s FAST campaign designed to quickly identify major symptoms
With one stroke happening every nine minutes across the country, Canadians increasingly recognize that the condition is a medical emergency that requires immediate attention. Time-sensitive in nature, treatments have changed dramatically over the last 20 years, with new breakthroughs saving lives.
“There was an era before 1990s where stroke patients were essentially parked in back of an emergency room as a non-urgent case, something for which nothing acutely interventional could be done,” says Dr. Andrew Penn, a neurologist based on Vancouver Island. “A stroke unit was a place you went to stop you from having pneumonia and clots in your legs, but there was nothing that really could be done for the damaged brain.”
That’s no longer the case, thanks to medical advances. A stroke happens when blood stops flowing to any part of the brain, damaging brain cells as a result.
Whereas there was a time when people would have had to live with a stroke’s potentially debilitating effects, treatment took an exciting turn in the late 1990s with evidence showing that thrombolytic drugs such as alteplase (tissue plasminogen activator or tPA) are effective treatments in some cases. Also known as a clot-buster, it’s given to certain patients who are having an ischemic stroke caused by a blood clot.
Although a remarkable discovery, scientists have recently learned that alteplase (tPA) is best used in clots that are less than a centimetre in diameter.
More recently, scientific study has uncovered the role that endovascular thrombectomy (EVT) plays in saving lives. This treatment involves threading a tube or other tools, including vacuums, through a large artery up into the brain using advanced X-ray imaging to pull out the clot. “This has been a phase where engineers are coming up with new and exciting ways to get a clot out, rather than have it flow downstream,” Penn says.
While new treatments are a cornerstone to enhanced outcomes, so too are improved guidelines, assessments and stroke systems. Just as people know that signs of a heart attack call for urgent care, more and more realize that no time can be wasted upon noticing any sign of stroke. That’s where Heart & Stroke’s FAST signs of stroke campaign comes in.
The acronym is an easy way to remember the major signs of stroke, standing for Face — is it drooping? Arms — can you raise them? Speech — is it slurred or jumbled? And Time — to call 9-1-1 right away. Quick action can mean the difference between life and death, or between a good recovery and lasting disability.
Just as individuals need to act on those initial symptoms, so do dispatch, ambulance and hospital personnel, so that patients get into the lab for diagnostic imaging.
“In the medical area of the brain, we have many specialities that work together, and it’s like changing tires at a speedway pit stop,” Dr. Penn says. “With new imaging and improved processing, we’re now able to get people in quickly, making sure that when they arrive [in hospital] there’s the least amount of delay.”
Telestroke is another notable improvement. With technology, people who have had a stroke or who have symptoms of a stroke who live in remote or rural locations can be connected with neurologists and other specialists in major centres. This is especially helpful given that some signs of stroke can resemble those of other conditions, such as migraines or seizures.
Maintaining a healthy weight, getting regular exercise and not smoking are among the ways people can reduce their risk of stroke. The good news is that more than 80 per cent of people who have a stroke and get to hospital quickly survive.
Penn reminds us: “Just like with a heart attack, if it’s deemed someone has had a stroke, you want to spring into action quickly.”