June is Stroke Month: Learn the signs of stroke and act fast

Dr. Andrew Penn, Heart and Stroke researcher, stroke neurologist, Victoria General Hospital

THERE are an estimated 62,000 strokes in Canada each year – that’s one stroke every nine minutes. Stroke is the third leading cause of death in Canada and a leading cause of disability, but new breakthrough treatments are helping to save more lives and improve quality of life.

“Twenty-five years ago, there was no intervention available,” says Dr. Andrew Penn, a Heart and Stroke researcher and stroke neurologist in BC. “Stroke patients were received in the emergency department and looked after on the wards, but it was just support; there was no treatment that would change the course of the stroke.”

That all changed in the 1990s, with the introduction of alteplase (tPA) – the “clot-buster” drug – that can dissolve blood clots and restore blood flow to the brain in many ischemic strokes, but only if administered within a few hours of symptom onset.

Now, a new breakthrough treatment has been shown to cut by half the death rate from major ischemic strokes and as well as a 30% increase in positive outcomes and reduced disability.

Dramatic results from the ESCAPE trial, co-funded by Heart and Stroke, are changing the way major strokes are treated in Canada and around the world. Using a procedure called endovascular thrombectomy (EVT), doctors insert a thin tube through a large artery, guiding it with advanced X-ray imaging through blood vessels to the brain. There, a retrievable stent or “stentriever” is used to remove the clot.

Heart and Stroke has been working to implement these findings into practice. This endovascular treatment is now included in the Canadian Stroke Best Practice Recommendations with a treatment window of six hours from stroke onset for most eligible patients — making Canada one of the first countries in the world to incorporate this treatment into its healthcare system.

Gail Pritchard was a beneficiary of this revolutionary treatment. While preparing her morning coffee last fall in Victoria, she suffered a severe stroke. “I remember saying something that didn’t make sense, and my arm wouldn’t move.” Her husband, Glen, who knew something was seriously wrong from her jumbled speech and inability to raise her arm, caught her as she fell, and immediately called 9-1-1.

Gail was lucky she arrived at the hospital as quickly as she did. The stroke team at her hospital used a stent retriever to pull a large blood clot from her brain.

Dr. Penn says EVT is having a profound effect on ischemic stroke outcomes. “Patients who would otherwise die, or become permanently disabled, are leaving hospital and returning to their families with reduced impacts.”

Brain cells die at a rate of 1.9 million per minute after a stroke, so the sooner blood flow can be restored, the better. It’s important that everyone learn the signs of stroke from Heart and Stroke’s FAST campaign and act FAST:

Face – is it drooping?

Arms – can you raise them?

Speech – is it slurred or jumbled?

Time – to call 9-1-1 right away.

Virginia Burgess, a paramedic with BC Ambulance Service, says if people don’t call 9-1-1 right away there’s a lot at stake. “It could be anything from their actual life to their quality of life, depending on the severity of the stroke and the ensuing medical issues the person might suffer.”

She says arriving by ambulance means you will get to the right hospital faster – one that is equipped to provide emergency stroke care. And there are other benefits too. “We can initiate treatments in the ambulance, as well as communicate to the stroke team and the physicians on the receiving end, so the timeline is streamlined and the patient has a better chance.”

Dr. Andrew Macpherson, ER physician and Trauma Team Leader at Victoria General Hospital, says stroke care today goes well beyond one doctor and a CT scan. “It’s the family recognizing that someone is having a stroke. It’s the 9-1-1 operator and the paramedics. It’s the triage nurse and the clerks, the emergency physician, the stroke nurse, the CT scan technician, the neurologist, the radiologist, and more. This huge team effort takes a lot to coordinate, and the outcome hinges on speed. Stroke is a time-sensitive disease.”

Learn more about breakthrough stroke research and the signs of stroke at: http://www.heartandstroke.ca/