How much time do you have to treat a stroke? The answer is: The first minutes and hours after stroke symptoms first appear are precious. And getting the right care as soon as possible is critical.
Why getting immediate stroke treatment is important
The sooner a stroke is diagnosed, the more quickly stroke treatment can begin. And the more quickly treatment begins, the better the outcome will be. Time is brain. For every minute the brain is deprived of necessary blood flow, 1.9 million brain cells die.
In the past, the most critical time after a stroke was often referred to as the “stroke window”, “stroke golden hour” or “stroke golden window”. Today, diagnostic imaging tests – which we’ll discuss more below – help us determine tissue damage and which treatments may be most effective. So, when we talk about the stroke treatment window, we mean the time between arrival at the hospital and when treatment begins.
That said, there are stretches of time when certain stroke medications and treatments can be most effective at improving the chances of survival and helping prevent long-term damage or disability.
For example, the sooner stroke medications – such as thrombolytic medicines like tissue plasminogen activator (tPA) – are given, the more effective they can be at reversing damage and improving outcomes. And if surgery is needed, sooner is better to help stop and reverse any damage.
This is why it’s so important for you to be able to recognize stroke signs and symptoms in yourself or loved ones, so you can call for emergency care as quickly as possible.
How a stroke is diagnosed so treatment can begin quickly
Step 1: Recognizing the symptoms of a possible stroke
The clock starts the moment the first symptom appears. Usually, stroke symptoms come on suddenly. And while not everyone will experience the same symptoms, face drooping, trouble lifting an arm or leg, and confusion or difficulty speaking (such as slurred speech) are some of the most common signs of stroke.
So, the first step starts with you: Be familiar with stroke signs and symptoms, and don’t ignore or dismiss symptoms you or a loved one may be feeling. The sooner you get the right care, the better the outcome will be – especially when it comes to a stroke.
Step 2: Stroke diagnosis
An accurate diagnosis as quickly as possible is vital. But how is a stroke diagnosed? In many cases, the diagnostic process naturally begins as soon as a patient arrives at the hospital. But leading stroke centers are finding ways to get started sooner.
For example, at Regions Hospital – which is a Comprehensive Stroke Center designed to deliver highly specialized care – stroke diagnosis starts with the paramedics and EMTs who respond to 911 calls. If a stroke seems likely, they coordinate with Regions Hospital emergency center by calling in a “Code Stroke.” The code alerts our team of stroke experts so they can be ready and waiting when the ambulance arrives.
After the patient arrives, the stroke team immediately takes them to a nearby imaging room for a CT scan, which helps identify a stroke. Inside the imaging room, the patient’s weight is taken, blood is drawn and lab tests are completed, all to save precious time.
Guidelines from the American Stroke Association (ASA), which is part of the American Heart Association, indicate that the CT scan should be started within 25 minutes of a patient’s arrival at the hospital. By partnering with more than 60 local EMS agencies to call the “Code Stroke” ahead of time, Regions Hospital has reduced this time to less than six minutes.
As the CT scan is being done, a neurologist who specializes in strokes is standing by to read the initial scan. This means that preparation for treatment can begin almost immediately if needed. Once a radiologist confirms the diagnosis, specially trained nurses are ready to administer the medication.
Step 3: Stroke treatment
There are two types of strokes: ischemic and hemorrhagic. And the type of stroke is what determines the course of treatment.
Ischemic strokes
According to the Centers for Disease Control and Prevention (CDC), 87% of all strokes are ischemic. Ischemic strokes happen when a blood clot blocks blood flow in the brain.
Ischemic strokes are most often treated with a clot busting medication called tissue plasminogen activator (tPA) or alteplase.
How do clot busting medications for stroke work? The medication is usually given intravenously, helping dissolve blood clots, restore blood flow in the brain and limiting the risk of damage.
Is there a “tPA window” for when medication is the most effective? Typically, medication needs to be given within three hours of when symptoms began. In some cases, that window can be extended to four and a half hours, or more. Another stroke treatment option is for specialized doctors to remove the clot by sending a catheter to the site of the blocked blood vessel.
Hemorrhagic strokes
Hemorrhagic strokes happen when a blood vessel ruptures. Hemorrhagic strokes are treated by controlling the bleeding in the brain and reducing blood pressure that may be contributing to the bleeding. Medications can be used, but surgical treatment may also be necessary.
Where to find immediate treatment for a stroke
Any time you or a loved one is experiencing stroke symptoms, getting to a hospital – particularly one certified in stroke care – as quickly as possible is the top priority.
But not all hospitals offer the same levels of stroke care. That means people can sometimes arrive at a hospital that can’t provide all the care they’ll need in one place. The good news is hospitals partner with each other so they can coordinate the best possible care.
The Joint Commission and the ASA offer four levels of stroke care certification:
- Acute Stroke-Ready Hospital – Acute Stroke-Ready Hospitals are equipped to provide timely, evidence-based care to stroke patients before transferring them to a Primary Stroke Center or Comprehensive Stroke Center.
- Primary Stroke Center – Primary Stroke Centers can stabilize stroke patients, and are able to treat ischemic strokes with tPA medications to dissolve blood clots.
- Thrombectomy-Capable Stroke Center – Thrombectomy-Capable Stroke Centers are able to treat ischemic strokes with catheter-based procedures (thrombectomies) to remove blood clots.
- Comprehensive Stroke Center – Comprehensive Stroke Centers can treat all types of stroke patients. But they also have the staffing, resources and expertise to provide highly specialized care for the most complex stroke cases 24 hours a day, seven days a week, and 365 days a year.
Know your local stroke care options
One thing you can do is learn what kind of care you have near you. For example, Minnesota is currently home to 92 Acute Stroke-Ready Hospitals, and 12 each of Primary Stroke Centers and Comprehensive Stroke Centers. In addition to the Regions Hospital Stroke Center mentioned earlier , our Methodist Hospital Stroke Center has also been certified as a Comprehensive Stroke Center.
Why is this kind of information important to know? It all goes back to the importance of getting the right care as quickly as possible.
The national average for the time between a patient’s arrival at the hospital and receiving clot-busting medication treatment begins is 76 minutes – which can increase if coordination for higher levels of care at another hospital is needed.
But at Regions Hospital, for example, the time from arrival to treatment on average is just 53 minutes. And those precious minutes saved can translate to significantly better outcomes.
Remember, for every minute the brain is deprived of necessary blood flow, 1.9 million brain cells die – that’s an average savings of more than 43 million brain cells. Plus, one study found that per 1,000 patients treated for ischemic strokes, beginning tPA treatment 15 minutes faster led to:
- 26 more patients with an improved ability to walk without assistance or walk fully independently at discharge.
- 13 more patients being discharged to a more independent environment.
- 4 fewer patients dying prior to discharge.
Award-winning stroke treatment and neurological care in the Twin Cities and western Wisconsin