By Lindsay Woolman
May 24, 2018
On the day of his stroke, he was lucky. Jason, who is in his late 40s, recalls experiencing symptoms very early in the morning as he prepared to leave for work. He stumbled and collapsed near his front door, feeling confused afterward. Fortunately, a coworker picked him up that day to give him a ride to work. He remembers thinking he was making sense as he tried to talk, and then not being able to speak at all. Approaching his workplace, Jason had a moment of clarity and wrote “stroke” on a piece of paper.
His coworker rushed him to McKay-Dee’s emergency room where he was evaluated in the early morning hours by Intermountain's TeleStroke team and later by one of McKay-Dee’s neurohospitalists. Because of the timing of his symptoms, the team was uncertain when the stroke first began, which could have been 7-8 hours prior.
“Thanks to new guidelines for acute ischemic stroke, he received crucial treatment due to a longer treatment window that was previously not available,” says Melissa McDonald, MD, a neurohospitalist at McKay-Dee.
The time limit for stroke treatment to remove blood clots used to be 4 1/2 hours for IV medication and 6 hours for what’s called intra-arterial therapy. But starting this year, the window for intra-arterial therapy has extended to 24 hours for select patients like Jason, who can benefit from a procedure called mechanical thrombectomy where a blood clot is mechanically removed.
To understand the significance, it helps to know what happens during a stroke. During an ischemic stroke, the blood flow to part of the brain suddenly stops and oxygen is cut off, causing millions of brain cells to die. For Jason, a large blood clot was located through a CT angiogram. For treatment, a catheter (a thin tube threaded inside an artery) was sent up to his brain to deploy a device to pull out the blood clot. Once the clot was removed, the blood flow returned. If the stroke had continued to progress, he could have permanently lost his language abilities, the use of his right side, or worse.
“While not all patients have a successful recovery like this one, Jason is a great example how the new stroke guidelines are working really well for some people,” says Dr. McDonald.
“The most important thing to know is that ‘time is brain,’” says Maria Jepperson, MD, an interventional radiologist who helped performed Jason’s procedure along with interventional radiologist Michael Webb, MD. “The more rapidly we’re able to recognize a stroke and provide interventions to restore blood flow, the more likely the patient is to have a positive outcome.”
Here’s what doctors recommend: