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Posted: Monday, March 23, 2015

New interventions for stroke patients improve outcomes

If you or someone you love has had a stroke, then you likely already know how important time is. In fact, time is everything. Strokes, of course, happen either when a blood clot blocks an artery or when a blood vessel breaks. When blood flow is stopped for more than a few seconds, the brain cannot get blood and oxygen, resulting in lost brain cells. For this reason, it’s critical to get to a stroke center for treatment as quickly as possible because, as the saying goes, “time is brain.”

At Blount Memorial, the key treatment for patients who are experiencing stroke symptoms is TPA (tissue plasminogen activator), also known as the “clot-buster.” This medicine can only be given within the first 4.5 hours of the onset of symptoms, which is a fairly narrow window. Once TPA is administered, many patients won’t need further treatment. New technology, though, has created options for those who do.

“At Blount Memorial, we already give TPA as fast as or faster than any other hospital in our region. So, for Blount County citizens, they should get here as soon as they can because we’re the closest, most-effective stroke center to them,” said Blount Memorial hospitalist and stroke medical director Dr. Deaver Shattuck. “Recently, at the international stroke conference, four landmark studies were released that really confirmed the care that we’re already doing. The conclusion was essentially that the best thing you can do for a stroke patient is to get them TPA as soon as possible, but what it went on to say was that, for select patients, it’s critical to move them on after they get TPA to get neurointerventional radiology. There aren’t a lot of neurointerventionalists in the country, and they only can intervene in about 5 percent of stroke cases. If they can intervene with those patients, the patients tend to do much better. We’re already doing that because we’ve already developed partnerships with neurointernventionalists in Knoxville,” Shattuck explained. “Because of that partnership, we can administer TPA quickly and send the patient to Knoxville if neurointervention is appropriate for them,” he added.

“If you’re having a heart attack, there are lots of things you can do to intervene,” Shattuck said. “There are stents, balloons and heart catheterizations that can be used. For many years, researchers have experimented with trying to find similar interventions for stroke, but the results have always been poor. This is, in part, because the vessels in the heart are different from the vessels in the brain. Usually a clot in the brain is soft, and needs to be retrieved and removed. The new intervention that has been developed uses new catheters that go up into the brain and actually cut the clot up and vacuum it out of the vessel itself. It really involves advancement in technology, and you get a good outcome,” he explained.

Ultimately, Shattuck says, despite new advancements in technology, time is still the biggest element in stroke care. “It’s all about getting the best-possible outcome. Most stroke patients will just need TPA, and will not need neurointervention. Time, of course, is a factor, which is why you want to get to the nearest stroke center as quickly as possible,” Shattuck said.

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