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DR. JASON STACY: Time is most important factor in promising stroke intervention

Northeast Mississippi Daily Journal - 3/30/2018

March 30--Mississippi has the highest rate of ischemic stroke in the Medicare population, according to the Centers for Disease Control -- 11.1 hospitalizations per 1,000 Medicare beneficiaries, to be exact.

Every year, there are more than 1,500 deaths from stroke in the state, making stroke Mississippi's fifth leading cause of death. Thankfully, more and more studies that show the effectiveness of stroke intervention mean stroke treatment is coming into maturity. It's very clear now that both IV clot busting drugs (Activase) as well as interventions to remove clots within the arteries (thrombectomies) are vastly superior to no treatment.

Treatment is much more effective when performed in less than three hours than past three hours, though past three hours patients treated as early as possible still had better outcomes than later or no treatment. Recently, the DAWN trial was published in the New England Journal of Medicine that showed effectiveness of thrombectomies up to 24 hours. Until now, Activase was only recommended by the American Heart Association up to 4.5 hours in some cases. Thrombectomies could only be performed up to eight hours. This significant trial opens up for patients possibilities that are a remarkable advance in stroke care.

The frustrating reality is that patients don't arrive in the emergency room in time to have the best outcomes. There are three main symptoms to look for when someone has a stroke: sudden onset of face weakness, arm weakness and speech difficulty. A patient can have one, two or all three of these symptoms. It is possible for strokes to present in less severe ways but extremely unlikely.

At the onset of these symptoms (or if someone wakes up with these symptoms), call 9-1-1. Stroke is an emergency that cannot wait. It is never OK to wait to see how you feel later or to see if the symptom passes. Every hour you wait significantly decreases your chances of being normal after the stroke. Even though patients treated with thrombectomy can still see benefit up to 24 hours, patients treated within three hours after stroke are 18 percent more likely to be independent than patients treated at eight hours (64 percent vs. 46 percent). Said another way, if you wait eight hours to get treatment, you're more likely than not to require permanent assistance the rest of your life.

Lastly, let me define getting treatment. When I say someone needs to get treatment within a certain amount of time, "treatment" means to receive the drug or intervention. It does not mean how long you should wait before calling 9-1-1. By the time you realize what is going on, call an ambulance, get transported to a hospital and get treated, you have consumed most of that three-hour window, and that is not counting the time it will take if the hospital you go to first has to transfer you to a hospital better equipped to treat stroke. To get treated in the amount of time needed to make it likely you will have a good recovery, you must call 9-1-1 within a matter of only a few minutes after you or someone near you experience the symptoms of a stroke.

Do not wait; help us help you by getting to a qualified stroke facility in time.

Dr. Jason Stacy is a neurosurgeon with North Mississippi Neurosurgical Services in Tupelo. After medical school, he completed a neurosurgery residency and endovascular neurosurgery fellowship at the University of Mississippi Medical Center in Jackson.

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(c)2018 the Northeast Mississippi Daily Journal (Tupelo, Miss.)

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