Fighting the War Against Stroke
Lotfi Hacein-Bey, MD
Medical College of Wisconsin
“To be successful in both prevention and treatment of stroke you need to have a complete program, including a specialized team.”
Each year more than 750,000 Americans suffer strokes. Stroke is the nation’s number one cause of adult disability and the third leading cause of death. What’s the outlook for the fight against stroke? Every Day talks with Lotfi Hacein-Bey, MD, to learn more.
Q: How is Froedtert & Medical College fighting the war against stroke?
We’re directing our efforts in two areas: prevention and treatment of acute stroke. You can think of stroke as a “brain attack”, much like a heart attack. But, unlike a heart attack, many stroke victims don’t realize they are having a stroke because the symptoms are hard to recognize and they come and go quickly. That makes treatment difficult because the most effective stroke treatment must be administered within three hours of a stroke.
Again, to compare stroke to heart attack, 35-40 percent of heart attacks are treated within the appropriate amount of time nationwide, but only 3-5 percent of strokes are. For that reason, it’s critical that people know more about stroke — what it is, its warning signs and the importance of fast treatment.
Q: What else is involved on the prevention front?
The Neurosciences Center at Froedtert & Medical College is home to our Preventative Cardiology Program. Here we evaluate and treat patients for risk factors associated with stroke or heart disease. Our specialists use diet, medical management, and exercise to help patients reach lower cholesterol levels, lose weight and control their blood pressure.
We’re also involved in clinical trials of new drugs. These include clot busters, that can reduce the risk of another stroke occurring, as well as those that can protect the brain, minimizing the long-term effects of stroke.
Q: What about treatment?
What is new in the area of treatment for stroke? As I alluded to before, the most effective treatment for ischemic stroke, or stroke that involves a blockage of blood flow to a portion of the brain, is a drug that must be administered quickly. Intravenous tissue plasminogen activator or tPA, if given within the first three hours of stroke warning signs, can destroy the blood clots causing the stroke. However, it’s important to know that tPA can be dangerous if inappropriately given. TPA and other clot—busting drugs may also be used transarterially that is, may be delivered right to the clot using catheter techniques by interventional neuroradiologists. Also, new clot-retrieving devices are available using the same technique, all need to be done within 5-6 hours of a stroke for it to be successful.
At Froedtert & Medical College, our Acute Stroke Team (or FAST) has been using tPA very effectively and safely since 1996. The team includes emergency room physicians, interventional neuroradiologists, critical care neurologists, neurosurgeons and designated stroke nurses who are on call 24-hours a day.
Of course, reducing the probability of additional strokes after one has already occurred falls into both categories of prevention and treatment — and this field is also blossoming. We’re making great strides with new angioplasty and stenting techniques that allow us to repair damaged arteries safely.
It’s important to remember, though, that to be successful in both the prevention and treatment of stroke, you need to have a complete program, including a specialized team. Most large hospitals have the basics covered, but that will take you only so far. To effectively fight stroke and make progress you need a responsive emergency/trauma facility, a neuro intensive care unit, interventional neurologists, neurosurgeons, programs and clinics that address prevention, a dedicated staff and all the latest resources. Not many facilities have all that, but Froedtert & Medical College does.
Did You Know?
Call 911 if you observe these symptoms:
- Sudden numbness or weakness of face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headaches with no known cause
Reduce Your Stroke Risk
Here are a few actions physicians recommend to reduce your chances of having a stroke:
Control High Blood Pressure. Most people can control it with diet, weight loss, exercise or medication.
Quit Smoking. Smoking puts extra strain on the heart — doubling your chances of a stroke.
Lower High Cholesterol, Lose Excess Weight, Get Enough Exercise, Moderate Your Alcohol Intake.
Take Your Medication. Books and resources about stroke prevention and treatments are available at Small Stones.