Rapid, Effective Stroke Treatment
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Rapid, Effective Stroke Treatment
Rapid Evaluation, Drug Treatment Can Change Strokeâs Course
When tissue plasminogen activator (tPA) hit the market nearly 20 years ago, the clot-busting drug was an absolute game-changer for acute ischemic stroke patients and the medical professionals treating them.
For some patients, tPA can completely change the course of their stroke, allowing for better outcomes and higher post-stroke quality of life.
âWe suddenly went from a state where an ischemic stroke was always a devastating, incurable cause of disability to a world where, in the right circumstances, a patient can be completely cured,â said Patrick D. Lyden, MD, director of the Cedar-Sinai Stroke Program. âThere has been nothing in neurology as big as tPA for stroke, and arguably there are few things in the history of medicine that is as big as tPA for stroke.â
Lyden, who also serves as the chair of the medical centerâs Department of Neurology, is one of the nationâs foremost authorities on stroke care and tPA. He was a major contributor to the pivotal clinical trial which led to the Food and Drug Administrationâs 1996 approval of the drug, and continues to delve into research about its use.
Tissue plasminogen activator functions mainly by improving blood flow to the brain after an acute ischemic stroke, and must be injected into a major artery within four and a half hours of the onset of stroke symptoms. If thatâs done, tPA can actually reverse the symptoms of a stroke. If not, the consequences can be permanent and debilitating â including impairments to speech, vision, cognitive ability, behavior and movement.
Rapid evaluation and action were vital in getting yoga instructor Susan Swan, 71, back in the studio and on the mat after her June 2010 stroke.
âIt was like there was a tornado in my brain,â Swan said, describing the day she collapsed in the middle of teaching a yoga session at Larchmont Village studio in Los Angeles. âEverything was all over the place, and when I woke up, I realized something major had happened.â
Although she doesnât remember much from that day, she does recall lying in an ambulance, racing west on Third Street toward Cedars-Sinai, where she was evaluated and a âCode Brainâ called, triggering the rapid response of the medical centerâs stroke team.
Swan received tPA within 45 minutes of her arrival in the Emergency Department.
Swan now leads an active, energetic life. She continues to teach yoga in her private studio, volunteers to help other Cedars-Sinai stroke patients during their time in the Neuroscience Critical Care Unit and helps lead the medical centerâs aphasia support group for patients learning to speak again post-stroke.
Shlee Song, MD, associate director of the Stroke Program, said the change tPA has brought to how stroke treatment is approached is immeasurable.
Before tPA, she said, patients diagnosed in the emergency room with a stroke were sent home and often asked to come back the next day, because there was nothing else to be done. Operational changes, such as the shift to rapid-response teams focused on immediate evaluation and treatment, are an outcome of the medical communityâs recognition of the positive impact tPA could have on patientsâ lives, she said.
The Stroke Program at Cedars-Sinai is a Joint Commission-certified Comprehensive Stroke Center, the highest possible quality-of-care designation, and consistently earns the American Heart Association/American Stroke Association Get With the Guidelines Gold Plus and Target: Stroke Honor Roll awards.
âWe have this competitiveness in our group in terms of getting faster âdoor-to-needleâ times, and every week we look at and evaluate those numbers,â Song said. âThe extraordinary collaboration between the emergency room and stroke teams has allowed us to achieve faster and faster times â sometimes even administering tPA within 30 minutes.â
Thatâs life-changing, said Lyden.
âWeâre talking about a cure â something that actually makes the stroke go away and often leaves the patient without any disability whatsoever,â he said. âThe success of tPA is frequent and the proportion of people who benefit is huge.â
Although Swan still works to overcome some lingering effects of her 2010 stroke, she says doesnât even like to think about how much worse the outcome would have been had she not received tPA so rapidly.
Her evaluation of the clot-buster is simple: âThe proof is in the pudding.â