A Stroke in Time

Significantly longer windows for treatment after initial stroke symptoms make it much more likely patients’ lives can be saved, but awareness is critical.

Dr. George Cravens has been spending a lot of time talking up stroke awareness.

May is National Stroke Awareness Month, and just last year, studies showed that a critical treatment for stroke patients is effective as far as 24 hours from onset of symptoms, three times longer than previously thought.

“We want to push this out,” Cravens, who recently gave a talk to personnel at MedStar, Fort Worth’s ambulance service, said recently in an interview at his downtown Fort Worth offices. “We’re trying to push up the standard of care.”

Why people should listen, Cravens says: “It’s dollars and cents, productivity. It’s huge; it’s devastating.”

Nearly 800,000 Americans suffer a stroke each year, according to the American Stroke Association. Stroke is the No. 5 cause of death in the United States, killing nearly 130,000 people a year, and it’s a leading cause of long-term disability and the leading preventable cause, the association says.

Stereotypically, older people are chiefly the victims. More women than men have strokes, partly because women live longer, the stroke association says. “And younger people have strokes, too,” Cravens says.

An estimated 87 percent of strokes are caused when a clot or mass blocks a blood vessel, cutting off flow to part of the brain, according to the association.

That means if you’re out to dinner with friends, and you witness potential symptoms, such as face drooping, changes in speech, or weakness in an arm, “it’s not, ‘Are you OK?’ ” Cravens says. “It’s call 911. You just probably saved someone’s life.”

Stroke treatments have advanced at a rapid pace over the last number of years, first with a drug called tPA, which, if administered within three to 4.5 hours of a stroke, can dissolve a clot.

Then another tool, a clot-removal procedure called thrombectomy, emerged, with a recommended four-hour window after symptoms. Subsequent studies widened that window to eight hours and, finally, last year, 24 hours. Eight hours “changed the game,” Cravens says. Twenty-four was an even bigger advance.

“The majority of strokes occur when people are asleep and don’t show symptoms until they awaken,” says Cravens, a member of the Texas governor’s EMS and Trauma Advisory Committee. “You’re now able to treat a huge increase in the number of patients.”

The broader window for the treatments also makes it more likely that rural patients can be airlifted to metropolitan comprehensive stroke centers in time, Cravens says. “They’re all bunched in the major cities; so, what do you do with those patients who are out in the rural areas? You get them to that place, and they do a CT scan, and they can CareFlite that person.”