A new stroke treatment provides more hope for patients
Acting quickly at the first signs of stroke is crucial. Here’s why.
Over the years, awareness has grown to help recognize stroke symptoms and act quickly, saving lives and livelihoods.
Ischemic strokes, or 80 percent of all strokes, happen when a clot blocks the flow of blood to the brain. The less common type of stroke is hemorrhagic in which an artery in the brain leaks blood or ruptures. Recognizing symptoms and acting quickly is key as “time is brain.” When blood flow is blocked, two million brain cells die every minute.
“Time is a huge factor,” said Dr. Michael Froehler, a neurointerventionalist at the Vanderbilt Stroke and Cerebrovascular Center. “We want you to get to the hospital as quickly as possible. Then, we treat you as fast as humanly possible.”
Acute ischemic stroke patients may receive tissue plasminogen activator, or tPA, to dissolve blood clots. The drug was approved by the FDA in 1996. “We have had evidence for 20 years that it works,” said Froehler. But, he explained that the drug works 10 percent to 20 percent of the time on bigger clots.
Patients say a relatively new stroke treatment is a miracle. This treatment uses clot-removal, but like all stroke treatments its success depends on time.
Time is of the essence
This new stroke treatment is for patients with large clots. It’s an endovascular surgery, or mechanical thrombectomy, in which a neurointerventionalist at a comprehensive stroke center threads a catheter through an artery in the groin up to the blockage in the brain. A stent-retriever opens up and grabs the clot, which is then removed.
Time is of the essence. The tPA must be administered within 3-4.5 hours of stroke onset. A mechanical thrombectomy should be done within about six hours of onset.
“I swear I felt it come out of my brain,” said Katie Giglio, who underwent the procedure at Vanderbilt after a stroke last year at age of 27. “Instantly, I could feel my face come back. It was pretty miraculous.”
Giglio had just finished a CrossFit workout and was driving to meet friends for lunch just a few miles away. A sudden bad headache hit and she felt her face droop. She lost her ability to move on her left side, but somehow managed to park at the restaurant and text a friend inside that she felt bad and couldn’t get out of the car.
Her friend, Melissa Wiley, a nurse practitioner who worked in the ICU at Vanderbilt at the time, knew immediately that this was a stroke. Giglio has ulcerative colitis, which is now in remission, but at the time was flaring up. One of its risks, which Giglio didn’t know then, is stroke.
Wiley called 911 and told EMTs to take her friend straight to Vanderbilt, bypassing a closer hospital.
As a speech therapist, Giglio had learned what tPA was but had not heard of the new procedure. Now, about a year later, the only lasting effect from her stroke is gratitude for every day.
This February, the Tennessee Stroke Registry Task Force gave its recommendations on identifying, diagnosing and treating strokes, which are the fifth leading cause of death in Tennessee. Froehler and his colleagues have examined data and continue to probe into questions about best protocol.
Last year, VUMC did about 100 thrombectomy procedures, said Froehler. This year, it will probably do about 120.
“It all happened within a 2-hour period,” said Giglio, who was at the restaurant at about 1:30 p.m. when it all started and recovering in a hospital room with her parents at about 3:30 p.m. after the procedure.
Her advice: “Don’t wait.”