When it comes to treatment for ischemic stroke, physicians have often relied on the saying, “time equals brain” – meaning that the faster a patient receives medical treatment, the greater chance that patient has for a successful recovery.
Until recently, that time was proven to be a six-hour window, during which physicians can utilize a combination of medication and/or endovascular treatment on stroke patients. But, according to a study published in the November 2017 edition of New England Journal of Medicine, that window can be as long as 24 hours for some patients. The neuroscience program at Valley Baptist Medical Center-Harlingen in Texas was a participant in this important study, known as the DAWN trial.
Traditionally, many stroke patients seeking medical treatment within six hours are treated with a combination of IV tPA – a medication that works to dissolve the blood clot responsible for a stroke – and mechanical thrombectomy, a procedure in which an endovascular neurologist inserts a catheter into a patient’s leg through the blood vessels to the brain to remove the clot, thereby reopening the clogged vessel and restoring blood flow to the brain.
“The DAWN trial looked at stroke patients from six to 24 hours, a group of patients that have never been looked at before, and proved that actually performing mechanical thrombectomy significantly benefited patients,” said Dr. Ameer Hassan, an investigator in the trial and head of the neuroscience department, director of endovascular surgical neuroradiology, and director of clinical neuroscience research at Valley Baptist Medical Center-Harlingen. “This is a big deal because we, as physicians, never had anything for patients outside of the six-hour window.”
Dr. Hassan said that as part of the study, patients received a number of tests to determine if they were viable candidates prior to treatment. Those who showed the necessary results and went on to receive endovascular treatment often experienced significant outcomes, Dr. Hassan said. In the study, 49 percent of patients treated had complete functional independence at 90 days.
The study is significant for stroke patients, many of whom seek medical treatment outside of the six-hour window. Recent studies have shown that just five to 13 percent of stroke patients receive treatment within three to six hours.
“If you suffer a stroke in the Valley, most people in Cameron County know that Valley Baptist is a Comprehensive Stroke Center, but they also know that ‘time is brain,’ and if a patient did not come in within six hours, there may not have been much to offer them,” Dr. Hassan said. “The majority of patients in South Texas present after six hours, hence the importance of this research for a region like ours.”
Valley Baptist Health System has the only Comprehensive Stroke Center South of San Antonio. Both Valley Baptist Medical Center-Harlingen and Valley Baptist Medical Center-Brownsville have received Gold Plus and Target Stroke Elite Plus honors from the American Heart Association’s Get With The Guidelines program, and are two of 13 Tenet hospitals to receive both honors.