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Going Beyond the Limit

Posted on May 24, 2018 in Stroke

Stroke Treatment Can be Effective Even When Hours Have Passed

Tammy Brooks of Crossville arrived by helicopter at Fort Sanders Regional Medical Center at least 24 hours – maybe even several days – after suffering an acute ischemic stroke.

That’s far beyond the four and a half-hour window for receiving the clot-busting drug alteplase and far past the six-hour cutoff for a mechanical thrombectomy, a surgery in which the clot is removed by a catheter guided to the site via the groin.

Most hospitals might have considered her “too late to treat.” But with its designation as a Comprehensive Stroke Center, Fort Sanders Regional is not “most hospitals,” and Keith Woodward, M.D., is not your typical neurointerventional radiologist.

“She was teetering on the edge of a massive stroke,” said Dr. Woodward. “That’s why we decided to open the clot, even though it had been over 24 hours and probably past what most hospitals would treat.”

Recent evidence shows that a mechanical thrombectomy can salvage brain function in one out of almost every three stroke patients as late as 24 hours after the stroke begins. The American Heart Association/American Stroke Association has amended guidelines to extend the recommended treatment window from six to 24 hours.

“When you get past 24 hours, you have to use judgment,” said Dr. Woodward. “We look at each patient and decide, ‘Will this patient benefit by removing that clot?’ When we see a small stroke and symptoms seem to be coming and going with the blood pressure the way Ms. Brooks’ symptoms were, that tells me the brain is still alive – it’s just not working. If we can restore the blood flow, we can restore function to that part of the brain.”

Immediately after Brooks had her stroke, her left arm and leg went limp, her face drooped and her speech slurred. Today, a slight weakness in her leg and paralysis in her arm are the only reminders of her ordeal.

It could have been worse. But Brooks’ brain had a network of “collateral” vessels that enabled blood to get around a blockage better than most. “If she didn’t have that ‘help,’ she probably would’ve had a pretty large stroke,” Dr. Woodward said. “She was continuing to worsen even past 24 hours. But we were able to salvage a lot of that tissue that was alive but not functioning. It probably helped get her speech back.”

About all Brooks remembers is “a lot of people coming to see me and being taken on a gurney to the helicopter.”

She remembers well, however, her ensuing stay at Patricia Neal Rehabilitation Center at Fort Sanders Regional, which has multiple accreditations for stroke rehabilitation. “Wowee! They are wonderful people there. Just good people with good personalities,” she said. 

Even with the lapse in memory about her treatment at Fort Sanders Regional, Brooks doesn’t hesitate to recommend the hospital known for its stroke care. “It’s a great hospital,” she said. “It’s the first place I’d go.”

For more information about the Comprehensive Stroke Center at Fort Sanders Regional, call 865-673-FORT or visit www.fsregional.com/stroke/ .