New Guidelines Expected to Improve Stroke Treatment

"This is going to make a huge, huge difference in stroke care," said Dr. William J. Powers, guidelines writing group chair and chair of neurology at the University of North Carolina School of Medicine in Chapel Hill.

New guidelines from the American Heart Association/American Stroke Association will make more stroke patients eligible for two critical treatments that are proven to reduce disability. Issued on Jan. 24, the guidelines cover acute ischemic stroke, which is the most common type of stroke and is caused by a blood clot that reduces or stops blood flow to part of the brain. Stroke is the second-leading cause of death in the world and a leading cause of adult disability that kills about 133,000 Americans every year.

The guidelines recommend that more people should be considered to undergo a procedure called mechanical thrombectomy, in which doctors remove blood clots using a device threaded through a blood vessel, and more people should be considered eligible for a clot-dissolving medication, alteplase. According to the associations' announcement, "Some patients may now have mechanical clot removal up to 24 hours after symptoms begin. The limit used to be six hours, but new research showed that some carefully selected patients may benefit even after an extended amount of time."

"This is going to make a huge, huge difference in stroke care," Dr. William J. Powers, guidelines writing group chair and chair of neurology at the University of North Carolina School of Medicine in Chapel Hill, said in their announcement.

It also quotes Dr. José Biller, a guidelines author and chair of neurology at the Loyola University Chicago Stritch School of Medicine in Illinois: "Removing blood clots from large arteries can mean the difference between stroke survivors being independent versus being dependent on others, which makes a big difference in their quality of life."

He said as many as 20 percent of ischemic stroke patients are currently eligible for clot removal, and that number will grow under the new guidelines and with further research.

The guidelines are published in AHA's journal Stroke and were announced at the American Stroke Association's International Stroke Conference; they are based on a review of more than 400 research studies and replace 2013 guidelines and all subsequent updates, Biller said.

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  • OHS Magazine Digital Edition - January 2019

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