Ultra-early treatment may boost stroke recovery

When it comes to treating a stroke, time is of the essence to reverse or minimize the effects.

According to a new European study published in the journal Stroke, ultra-early treatment of an ischemic stroke may increase the chances for recovery – ideally within 90 minutes of the onset of stroke symptoms.

The 14-year study tracked data from more than 6,800 patients in 10 stroke centers in Europe. Researchers concluded that patients with mild to moderate stroke benefited the most from receiving treatment within 90 minutes compared to receiving treatments up to 4.5 hours from the start of symptoms.

According to Dr. Steven Zahn, medical director of the emergency department at Advocate Sherman Hospital in Elgin, Ill., the current guidelines in the United States is to provide tissue plasminogen activator (TPA), a clot-dissolving medication, within 4.5 hours of stroke symptoms.

“Clearly, for a certain population of stroke patients, there is greater effectiveness and better outcomes if the medication is given within 90 minutes,” Dr. Zahn says. “That’s why it’s so important for people experiencing stroke symptoms to come to the emergency department immediately so treatment can be started as soon as possible.”

The Centers for Medicare and Medicaid Services recommends that hospitals nationwide complete the stroke diagnosis process in 45 minutes or less upon a patient’s arrival. This process includes an evaluation, blood test and CT scan to determine the type of stroke and best treatment.

“It is possible for a stroke patient to receive TPA within 90 minutes; however, this is dependent on how quickly the family or friend of the patient can recognize stroke symptoms and get to the hospital,” Dr. Zahn says. “Paramedics play an important role by alerting the ED that a stroke patient is coming to the hospital, so we can begin the stroke diagnosis process immediately.”

The study acknowledges that patients with severe stroke may not benefit from ultra-early treatment. During a severe stroke, a patient may require surgical treatment, Dr. Zahn explains.

“While TPA is an excellent medication for treating stroke, a severe stroke (those higher on the NIH stroke scale) is more subject to complications from the medication. As a result, a patient could have significant bleeding inside the brain even if TPA is given within 90 minutes.”

Dr. Zahn acknowledges that these findings may call for more streamlined processes leading up to stroke treatment, including symptom recognition, transportation to the hospital and the diagnosis process.

“In the end, these finding may push hospitals to diagnosis stroke symptoms even faster than the standards currently in place,” he says. “However, the current standard in the United States is very high.”