Just the thought of a stroke is frightening. But there is good news—today’s new treatments mean that strokes are treatable…and beatable!
The most common type—acute ischemic stroke, which accounts for about 80% of strokes—occurs when a blood clot lodges in an artery in the brain, interrupting blood flow and, all too often, resulting in the death of brain cells. In 1996, the Food and Drug Administration (FDA) approved the clot-busting drug tissue plasminogen activator (tPA) to treat acute ischemic strokes. This was a huge win for stroke sufferers and physicians who, until then, had few treatment options other than hospital bed rest and a wait-and-see approach. Because of tPA, not only could millions of patients survive a stroke, they often could avoid—or at least limit—the disability that sometimes resulted.
But there was a catch—tPA had to be injected within three hours of symptom onset. In fact, nearly two million brain cells die every minute that a stroke goes untreated. The faster treatment is administered, the greater the chance of recovery. But even now, nearly three decades after tPA’s approval, only 3% to 5% of stroke patients are treated within the three-hour window, primarily because many of us don’t recognize the signs of stroke.
Good news: Decades of research and real-world practice have shown that most acute ischemic stroke patients can be successfully treated with tPA within 4.5 hours of the onset of symptoms. Even though the FDA has not yet approved using tPA beyond three hours after onset, doctors often use it off-label.
There are more exciting advancements in stroke treatment, rehabilitation and prevention. For the 800,000 Americans who experience a stroke every year—that’s one stroke every 40 seconds—it is possible to survive and even thrive.
Development #1: Endovascular thrombectomy (EVT) to remove clots. About 10% of ischemic strokes—typically the most neurologically debilitating type of stroke—can be treated with this procedure, where a clot (also known as an embolus) is manually removed via a microcatheter or other surgical tool, restoring blood flow to oxygen-deprived brain regions and potentially reversing the effects of the stroke. Advanced imaging technology allows doctors to measure the size and location of the stroke and assess the loss of blood flow and damage. If the scans show that the clot is blocking a large vessel and the stroke has occurred in an area of reversible injury, the patient is a candidate for EVT. (Clots in small vessels don’t respond well to this procedure.)
EVT was approved five years ago to be used within six hours of stroke onset, but recently, we’re seeing benefits when this procedure is used up to 24 hours after onset. EVT typically is used in conjunction with tPA—tPA is administered first. Unfortunately, if imaging scans reveal that permanent damage has already occurred in a large area of the brain, EVT is not likely to be beneficial, and removing the clot actually increases risk for further bleeding.
Development #2: Vagus nerve stimulation (VNS) may help recovery. VNS involves delivering painless electrical impulses to the vagus nerve, which extends from the brainstem to the colon and branches out into the lungs, heart, stomach and other organs. VNS has been used for years to treat epilepsy, depression, chronic headache and other brain disorders. In 2021, the FDA approved it for chronic stroke patients—people who experienced a stroke at least six months ago and still have residual impairment, specifically persistent impairment in the upper body, hands or arms.
How VNS works: A matchbox-sized device is surgically implanted under the skin of the chest, and coils, called leads, are wound around the vagus nerve in the neck. A week after the outpatient procedure, the device is wirelessly activated, and a therapist begins delivering pulses to the vagus nerve while the patient performs upper-body tasks. Eventually he/she learns to use the device at home. Stimulating the autonomic nervous system (which shoots messages between the brain and body) may help the body adapt to improvements made through physical therapy. VNS itself isn’t helping the brain to heal—once an area of the brain has been damaged by a stroke, the injury is irreversible—but it may help form neural connections that prime the body and brain to relearn certain movements. VNS even can be used with patients whose stroke occurred years ago.
Exciting: In a groundbreaking clinical trial by researchers in the US and Europe published in The Lancet in 2021, stroke patients with moderate-to-severe arm weakness who received VNS during physical and occupational therapy (six weeks of in-clinic treatment, followed by 12 weeks of at-home treatment) regained two to three times more motor function in their upper extremities compared with those who underwent rehab with no VNS.
Development #3: Flu vaccination may help prevent strokes. Seasonal influenza (“the flu”) increases risk for ischemic stroke and heart attacks, most likely because the virus causes systemwide inflammation. Mounting evidence suggests that influenza vaccination may lower stroke risk by triggering an anti-inflammatory immune reaction. A promising study involved more than 14,000 people who had experienced one ischemic stroke, plus about 72,000 people who had not had a stroke. Researchers from University of Alcalá found that people who had received a flu vaccine were 10% to 15% less likely to experience a first stroke versus unvaccinated individuals. Even better: The protection extended until the start of the next year’s flu season. Ask for a high-dose flu vaccine, which contains four times as many antigens as traditional flu shots. If that isn’t available, the standard flu vaccination remains a smart idea.
Recognize The Symptoms of Stroke
Many people know that slurred speech and/or a drooping face are signs of stroke, but other less-recognized symptoms warrant attention.
Example: A 70-year-old Russian literature professor’s colleagues noticed that she seemed unusually despondent and her speech seemed flat and unemotional one day. Diagnosis: She had experienced a small stroke on the right side of her brain in an area that controls the emotional aspects of speech.
The acronym B.E.F.A.S.T. can help you recognize stroke symptoms…
Balance (sudden issues with coordination…dizziness or falling)
Eyes (sudden vision loss or uncontrollable eye movements on one or both sides)
Face (sudden drooping on one side)
Arms (when arms are lifted, one arm suddenly drifts downward)
Speech (sudden slurred or nonsensical speech, writing or texting…trouble understanding what someone else is saying…uncharacteristic changes in the way a person communicates)
Terrible headache (especially accompanied by nausea and vomiting—this can be a sign of a bleeding stroke).
In women, the following little-known signs also may be observed: Hiccups…chest pain or shortness of breath…nausea…unexplained fatigue.
Remember: Time is of the essence. Head to a hospital or stroke center immediately if you notice any of these in yourself or someone else.
