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July 21 2016

Medication, intervention target clots to help save stroke patients’ lives and reduce disabilities

By Andrew Cardoni, MD

No one knows when a stroke will occur. The best ways to combat stroke are to be healthy, know the signs of stroke and act quickly if symptoms occur.

Similar to a heart attack, a stroke is a brain attack. It’s the leading cause of serious, long-term disability in the U.S. and the third leading cause of death. Signs of stroke may include facial numbness or drooping; arm or leg weakness; speech, vision and balance difficulties; confusion; and severe headache.

While each stroke is unique to the individual, emergency treatments for acute stroke have something in common: They are designed to rid the body of the blockage that caused the stroke, save brain cells and allow the patient to regain function.

Medical treatments for achieving a good outcome after an acute stroke include an intravenous medication called tissue plasminogen activator (tPA) and an interventional catheterization procedure that removes the blockage.

When a stroke patient arrives at the hospital, members of the medical team conduct a brain CT scan, EKG and blood tests to determine whether a patient is a good candidate for tPA or an interventional procedure. As with all medical procedures, the patient’s health and safety are the highest priority. In the case of stroke care, advanced diagnostics are essential to aiding the medical professionals in determining the appropriate treatment for the patient within a certain window of time.

Tissue plasminogen activator (tPA)

TPA is considered the gold standard for acute stroke care. It is the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke caused by an occlusion, or blockage, within a blood vessel supplying blood to the brain. Approximately 70 percent of strokes are diagnosed as ischemic at ProHealth Care hospitals. TPA medication has serious risks and can be given only to patients who have been thoroughly screened.

Administered through an IV, tPA travels to the brain and begins to break up the blood clot and restore blood flow. If administered quickly after the start of stroke symptoms, tPA can significantly reduce the effects of stroke and the chance for permanent disability. The national goal for treatment of stroke with tPA is 60 minutes from arrival at a hospital to treatment.

Interventional radiology

If a stroke patient arrives at the hospital within 10 hours after a stroke begins, physicians may determine that the patient is eligible for an interventional radiology procedure to remove the blockage. This decision is made based on a CT angiogram and CT perfusion. These advanced imaging capabilities allow the medical team to determine the location of the blockage, how much of the brain has been affected by the stroke and how much remains at risk.

A mechanical thrombectomy is an interventional procedure in which an interventional radiologist inserts a catheter into an artery in the patient’s groin and, with on-screen X-ray guidance, threads the catheter through the body to the blockage in the brain. The physician retrieves the clot using a suction device, removing it from the body through the catheter and restoring blood flow and oxygen to the brain. ProHealth Waukesha Memorial Hospital is the only Waukesha County hospital where mechanical thrombectomy is performed.

Whether tPA is administered or a thrombectomy is performed, timing is of the essence. A well-orchestrated team of medical professionals works together to assure that the best treatment is provided to the patient as quickly as possible and that treatment also includes excellent post-acute care, and oftentimes rehabilitation.

If you are concerned about the potential for you or a loved one to experience a stroke, be sure to talk to your health care provider. You also may wish to take a free health risk assessment for stroke at ProHealthCare.org/KnowYourRisk.

Learn about the signs of stroke — and don’t hesitate to call 911 as soon as they appear.

Andrew Cardoni, MD, is medical director of the emergency department at ProHealth Waukesha Memorial Hospital and co-director of the ProHealth stroke program. Cardoni is board-certified in emergency medicine.


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For more than a century, ProHealth Care has been the health care leader in Waukesha County and surrounding areas, providing outstanding care across a full spectrum of services. The people of ProHealth Care strive to continuously improve the health and well-being of the community by combining skill, compassion and innovation. The ProHealth family includes ProHealth Waukesha Memorial Hospital, ProHealth Oconomowoc Memorial Hospital, ProHealth Rehabilitation Hospital of Wisconsin, ProHealth Medical Group, the UW Cancer Center at ProHealth Care, Moreland Surgery Center, ProHealth AngelsGrace Hospice, ProHealth Home Care, ProHealth West Wood Health & Fitness Center and ProHealth Regency Senior Communities. Learn more at ProHealthCare.org.