The bad news: “There are substantial geographic disparities in stroke mortality, with higher rates in the southeastern United States, known as the “stroke belt.”…. The overall average of stroke mortality is 30 percent higher in the stroke belt than in the rest of the nation,” the March 2017 issue of Circulation reported.
The good news: There have been major advances in acute stroke treatment. In the past, a clot lodged in a large artery supplying the brain meant death or severe disability. Now there are multiple devices that research has shown effectively treats such a clot and restores blood flow. The problem is getting patients to certified stroke centers in time.
You often hear the phrase “time is brain” when referring to stroke care. The time that lapses from the onset of symptoms to the treatment for stroke is a huge factor in determining how significant its effect will be. The urgency is illustrated in this time line for a recent patient, a 47-year-old woman:
▪ 3:20 p.m. — Patient suddenly falls in the kitchen. Noticing inability to speak, facial and arm paralysis and visual impairment, family calls 911.
▪ 3:40 p.m. — An ambulance arrives, and the crew immediately understands the severity of the stroke.
▪ 4:24 p.m. — Patient arrives at the emergency department. A CT scan is performed within two minutes to exclude deadly bleeding. A stroke specialist and an emergency department physician diagnose a likely stroke. Within 18 minutes, she begins receiving a “clot-busting” medication.
▪ 4:47 p.m. — A CT perfusion scan confirms a “large area” of diminished blood flow to her brain. The cath lab team is notified, and the patient is transferred to the catheterization suite for surgery. The neuro interventionist documents her blood flow as “restored to near normal” at 6:30 p.m., three hours and 10 minutes after her fall at home.
▪ In 24 hours, her stroke severity rating decreased 25 percent; in one week, 50 percent. Her rehabilitation is promising.
Living in the “stroke belt” doesn’t have to mean deadly cardiovascular disease is inevitable. Identifying the risk factors and how to treat them is known to decrease mortality from stroke.
Baptist Health Lexington is sponsoring a free stroke risk factor screening from 9 a.m. to 4 p.m. May 19 near the Dillard’s inside entrance at Fayette Mall in Lexington. Blood pressure, cholesterol, blood sugar, heart rhythm, carotid artery screening, weight and physical activity will be analyzed to predict stroke risk.
Jane Van Tatenhove is the stroke program coordinator at Baptist Health Lexington and a joint commission stroke reviewer.