Recognizing Symptoms, Prompt Treatment Can Minimize Stroke Impact

By Sarah Gooding
Friday, June 23, 2017

Members of the Kansas Initiative for Stroke Survival are working to improve awareness and outcomes.

Hartej Sethi, MD

Multiple studies have reinforced the importance of prompt treatment of stroke symptoms.

Hartej Sethi, MD, a neurologist with Stormont Vail Health in Topeka, says physicians are working to utilize that research to save as many lives as possible.

“The stroke studies that made a huge impact on stroke care in the U.S. were mainly in 2015, when there were five different trials that came to the same conclusion: If you treat a huge stroke early with interventional treatment, that can result in a dramatic improvement in stroke outcomes,” Dr. Sethi says.

As a member of the Kansas Initiative for Stroke Survival (KISS), Dr. Sethi is working with others to translate those study results into awareness and better outcomes.

“What we try to do is educate people in Kansas about the importance of time, to recognize stroke symptoms and to seek treatment immediately,” he says.

One of the challenges is helping ensure patients are able to promptly access a fully equipped stroke care facility with an interventional neurologist or radiologist who is fluent with the procedures involved in getting clots out.

From the onset of stroke symptoms, time is of the essence in order to minimize a stroke’s impact.

“The current recommendation is six hours,” Dr. Sethi says. “At the six-hour time point, you have to be able to initiate or start that procedure.”

However, he says, the time window is a moving target, with some treatments, such as intravenous tissue plasminogen activator (tPA), securing optimal results for ischemic-type strokes in the first three to 4.5 hours. Meanwhile, studies are being done to see if interventional procedures could still make a difference within a 24-hour window, if tests can show that certain areas of the brain are salvageable outside of the core stroke.

“If we’re able to document that on our CT perfusion study, we can expand that window well beyond the six hours,” Dr. Sethi says. “That data has not formally been endorsed yet, but we’re looking at that possibility very shortly.”

Physicians now also have more tools at their disposal to get the clot out, including stent retrievers — which can revascularize that part of the brain — and the traditional MERCI and Penumbra clot retrieval catheters.

With increases in technology available, Dr. Sethi said it is important to help the general public recognize symptoms of both a stroke and of transient ischemic attack (TIA), or “ministroke.”

While those symptoms can appear to resolve on their own, Dr. Sethi says it is critical that patients report these events to their primary care doctors and that the PCPs refer the patients to a neurologist, who then can admit patients to a stroke-ready observation unit, such as one offered by Stormont Vail, or an emergency room.

“These particular conditions increase your risk of having a full-blown stroke to a dramatic degree — 8 to 10 percent within the next 30 days,” Dr. Sethi says. “A lot of times, physicians don’t realize how important it is to get stroke evaluated sooner than later.”

He says that early evaluation allows patients better flow-through and cost-effectiveness of care, particularly if they can prevent a full-blown event.

“For stroke, it’s much more true than any other disease: Prevention is better than cure,” Dr. Sethi says.