blood clot in an ischaemic stroke
Posted in Best practices/emergency care For the general public

Clot removal effective even after six hours

It is good news; until 2018, we knew that neurosurgeons can salvage living neurons only if they remove the clot within six hours of the block. Now, we know it is not so. They can go ahead with the operation if a patient is ready for the surgery even after six hours.

About the study

This finding was published in the The New England of Journal of Medicine in 2018. An eminent group of US researchers conducted this study recruiting stroke patients from 32 stroke centres; so, it was a multi-centre study. They compared recovery levels of two groups of stroke patients after three months; one group received only the clot-buster drug and the other group underwent the clot-removal operation. They prematurely terminated the study after evaluating the results of 182 patients – the result was so obvious – after three months, 45 per cent of people became functionally independent as against 17 per cent of those who received only the clot-buster drug.

This study was about ischaemic stroke. In an ischaemic stroke, brain cells die as a result of a block to blood flow by a blood clot. More than two-thirds of strokes occurs due to a blood clot. There are other types of stroke too. Read about stroke types through this link.

Clot removal surgery (Thrombectomy)

The following caption was published in the NIH Director’s blog. As we all can see, a tiny tube is sent to the blocked area to retrieve the clot.


Caption: Schematic of how the clot retriever used in the reported trials is opened inside a blood vessel to surround a clot that is blocking blood flow. Once caught by the stent, the entire apparatus with the clot is removed from the body out a small puncture in the femoral artery at the groin.
Credit: Covidien

This is not a reason to delay in seeking medical attention!

However, this does not mean that anyone suspected of having a stroke can afford to delay seeking hospital care; we should ideally receive specialised care within the first hour of a suspected stroke – even earlier the better. One with a confirmed diagnosis should receive the clot-buster drug within the first hour from the “last known normal”. you can read about it more through this link.

The New York Times provided wide publicity to this remarkable discovery in their January 24th publication in 2018.

chase the golden hour
Posted in Best practices/emergency care For the general public

What does “golden hour” mean in stroke care?

Imagine the following trail of events: you start to observe one or more F.A.S.T. stroke symptoms and signs in a person; you call an ambulance; emergency responders arrive at the scene; they determine of a stroke; they rush the person to a stroke unit; the person is treated with a blot clot-dissolving medication.  If all these events occur within the first hour from the time of detection, that is the golden hour.

This is because of every passing second matter. Ans this is why we call, “Time is Brain”. Read about it more on the “Journeys to the Brain” series.

Time is the critical factor; 32,000 neurons die ever passing second as Jeffrey L. Savers wrote in 2005.

Why this hour is golden? 

A group of Scandinavian researchers (Advani et al. 2017) have shown that irrespective of age and pre-existing disease conditions, those who were treated within this golden hour reached excellent outcomes. This is a very significant finding because age (how much old an individual is) should not be considered as a factor to call for an ambulance and to intervene at the hospital. 

Not only they, but other researchers have also demonstrated the importance of this hour.

However, passing this golden hour does not mean that we should lose our hope of salvaging the affected brain tissues. The Canadian best practice guidelines advocate the onset-to-needle time as “four and a half hours” (page 3) from the onset of symptoms. 

References 

Advani R, Naess H. & Kurz M.W. (2017). The golden hour of acute ischemic stroke. Scand J Trauma Resusc Emerg Med. 2017 May 22;25(1):54. doi: 10.1186/s13049-017-0398-5.

Remember the F.A.S.T. Campaign by NHS
Posted in Emergency care best practices

How to suspect a stroke

FAST campaign from the University College London hospitals (Courtesy: University College London Hospitals website.

The above public health message summarizes the signs and symptoms of a suspected stroke event.

In this creative message, each letter represents a word:

  • F : face,
  • A :arms,
  • S : speech,
  • T : time.

Knowing what these letters represent is not enough. We need to ask its associated specific questions.

How to suspect a stroke

  1. Look at the face

    Ask: can you smile?
    Observe: whether one side of the mouth or an eye is drooping

  2. Compare both arms

    Ask: Raise your both arms
    Observe: Whether the person is having any difficulty of raising one or both arms

  3. Observe the speech

    Observe: whether the person cannot speak or understand as before

  4. Check the time

    Call an ambulance of you observe any one of the above

Time is the critical factor; 32,000 neurons die ever passing second.

Other similar public health messages

The following are several popular messages adopting the same acronym technique. Among many, I chose the above one because its visuals explains everything that we should know succinctly.

Heart and Stroke Foundation of Canada message
Figure 1: Canadian Heart and Stroke Foundation campaign poster (Courtesy: Canadian Heart and Stroke Foundation)
University College of London (England) Hospitals message
Figure 2: FAST campaign from the University College London hospitals (Courtesy: University College London Hospitals website)
American Heart Association message
Figure 3: The US campaign (Courtesy: American Heart Association/American Stroke Association)