Stroke afflicts 700,000 people each year, but treatments available are far from ideal. TPA, a clot-busting drug, is the best bet so far, but it doesn't work for everybody. Here's the need-to-know on the latest options for stroke treatment and how to reduce your risk of stroke.
1. Get to the hospital pronto. TPA, the one time-tested treatment for acute stroke, needs to be administered in the first few hours after a stroke in order to dissolve blood clots and restore blood flow to the brain. A new study has found that tPA can be given as late as 4½ hours after a stroke without significantly increasing the risk of side effects such as bleeding in the brain. Three hours was previously considered the limit. Another 20,000 people a year could be saved from stroke damage with this larger window, says Lee Schwamm, vice chairman of the neurology department at Massachusetts General Hospital. This does not mean lollygagging en route to the hospital; call 911. Schwann says: "The faster you treat, the better patients get."
2. Know what a stroke looks like. In order to get treatment in the tPA window, you have to know it's stroke. The five most common symptoms: sudden problems walking, talking, reaching (with one side weak or numb), seeing, and a bad headache. "Sudden" is the key clue. (Temporarily experiencing one of these symptoms may mean you're at risk of having a stroke.)
3. Get scanned fast. CT scans help doctors determine if a stroke is caused by a blood clot (ischemic stroke) or by bleeding in the brain (the less common hemorrhagic stroke). TPA can't be used for hemorrhagic stroke; instead, the treatment includes drugs to lower blood pressure and reduce brain swelling, and perhaps surgery. The faster the brain scan, the faster one brain-saving treatment or another can be started.
4. Clot-grabbing gizmos aren't yet ready for prime time. In the past two years, the FDA has approved two devices, a minicorkscrew and a minivacuum cleaner, for removing clots from arteries. However, no research has been published on their effectiveness in treating stroke. They may end up being useful for patients with clots too big to be dissolved by tPA, or who for various reasons can't take tPA.
5. Preventing a stroke is better than treating one. Because of the limited treatment options, the government and the American Heart Association are pushing prevention. Best bets are to control high blood pressure; control diabetes (an unusal new approach to diabetes control emphasizes reducing blood pressure over glucose levels); stop smoking; get treatment for atrial fibrillation, which can cause clots; and keep cholesterol numbers down.