You rise in the dead of night to your loved one behaving strangely. The signs of a stroke are serious and terrifying: weakness in half the body, trouble producing and understanding speech, and altered vision. Immediately you recognize something is wrong, but can the wrong be righted? You fear too much time has passed and that the disability may become permanent. You find yourself asking “What if I had just woken up sooner?”
When it comes to the intervention of a stroke, a timely manner can mean the difference between life and death. With stroke, blood flow is interrupted to a portion of the brain. Depriving the brain’s neurons of nutrients and oxygen, stroke prevents proper functioning and causes damage to the brain’s ever fragile tissue. With a death rate of two million brain cells per minute, prolonged lack of blood flow can cause irreversible destruction resulting in loss of brain function and disability.
When caused by a blood clot in the brain vasculature, and caught early, a stroke is often able to be treated with clot removal techniques before significant death of tissue occurs. Medical professionals can de-clot with the intravenous administration of emergency stroke drug, tPA, or with a procedure known as a mechanical thrombectomy. In a mechanical thrombectomy, a neurovascular device is deployed within the blood vessels of the brain, and used to physically grab and remove, or vacuum out, the bedeviling clot. These methods of intervention have been used for some time.
Intervention, however, is only recommended within a limited time frame. Dubbed the “golden window,” the six hours after stroke onset were once thought to be the period of time during which intervention was most effective at minimizing or preventing damage. Intervention rarely occurred outside the window, and patients who arrived late to the hospital were often left with clots, tissue death, and impairment. However, new research suggests that the window for intervention may be larger than previously advised.
New guidelines released by the American Heart Association and American Stroke Association in January 2018 recommend an increased treatment window for clot removal up to twenty-four hours post-stroke. The recommendations came in light of results of the DAWN and DEFUSE 3 trials; trials which illustrated the benefit of mechanical intervention up to 24 hours after onset of stroke.
The expanded intervention window is anticipated to lower the risk of disability for an astounding number of future stroke patients who would not have been treated following previous guidelines. Though time remains of the essence for the treatment of stroke, this expanded window gives hope to loved ones who fear they weren’t quick enough.