William J. Powers, M.D., FAHA, H. Houston Merritt Distinguished Professor and Department Chair, Department of Neurology, University of North Carolina at Chapel Hill; Chair, Writing Group, AHA/ASA 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke
Just a few years ago, stroke dropped from the nation’s No. 4 killer to No. 5, yet it still kills more than 130,000 people every year.
That’s why the American Heart Association/American Stroke Association hasn’t rested in its determination to treat and beat stroke — and that’s why today we released new acute ischemic stroke treatment guidelines at our International Stroke Conference in Los Angeles.
Two of the recommendations are notable because they will help more people benefit from certain treatments for ischemic strokes. Ischemic strokes, which involve a blood clot blocking a blood vessel to the brain, account for 87 percent of all strokes.
- The treatment window for a clot-removing procedure has been increased from six hours to up to 24 hours for select patients under certain conditions. This procedure can be effective over a broader time window after an ischemic stroke, according to the latest research.
- More patients may be eligible for alteplase, a clot-dissolving drug that restores blood flow to the brain.
The full guidelines detail recommendations for the comprehensive stroke system of care — from emergency response systems to hospital treatment with specific therapies. Two other authoritative medical groups have endorsed the guidelines, which are based on more than 400 peer-reviewed studies and are the most comprehensive for treating ischemic stroke since 2013.
Although the guidelines are most relevant for healthcare professionals, here are three things everyone should know about stroke.
- Learn to recognize the warning signs — and get care fast. We must continue to improve public knowledge of stroke warning signs and risk factors, which can help prevent strokes from ever happening. Our F.A.S.T stroke campaign, developed with the Ad Council, makes the sudden signs and symptoms easy to remember:
F – Face Drooping
A – Arm Weakness
S – Speech Difficulty
T – Time to Call 911
Sometimes other symptoms appear, separately or in combination with F.A.S.T. signs.
- Wait for the ambulance – don’t drive. Stroke patients who use emergency medical services get to the hospital sooner, and they receive a quicker evaluation and more rapid treatment. Calling 911 instead of having a friend or family drive a stroke patient to the hospital can make a big difference, yet only about 60 percent of all stroke patients use EMS.
- Understand how cultural competence is critical to increasing stroke awareness. Cultural factors and issues can lead to disparities in stroke outcomes. For example, black and Hispanic patients have lower stroke awareness than the general population and face an increased risk of delays in seeking care. In addition, males, black people and Hispanics are less likely to use EMS. We must carefully tailor educational efforts, because public awareness interventions vary in effectiveness by age, sex, race and ethnicity.
As the AHA/ASA continues to build healthier lives, free of cardiovascular diseases and stroke, the Centers for Health Metrics and Evaluation will help us quantity our impact. The new stroke guidelines show how we use high-quality evidence to share the most current, comprehensive recommendations for providers at the front lines of stroke treatment.
It’s my hope that the guidelines will improve awareness and lead to faster action, helping patients get the best care possible and pushing stroke farther down the list of killers.
- 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke
- News Release
- News Story
- Together to End Stroke