When a stroke strikes, minutes can be priceless
When a stroke strikes, minutes can be priceless

When someone is having a stroke, there's no time to waste.

"The brain is just unforgiving for lack of oxygen, so minutes count,” said Dr. Charles Morgan, medical director of Integris Stroke Center of Oklahoma.

Clot-dissolving drugs must be given within three hours of a stroke or the risk of bleeding in the brain is too great.

"By far, the most common reason for not being able to give it is people wait too long,” Morgan said.

Doctors at Mercy Health Center say they are using a method that doubles the treatment "window” for stroke patients from three to six hours.

Instead of the commonly used and accepted method of injecting a clot-busting drug intravenously, Mercy physicians give the drug intra-arterially, meaning they feed a catheter through the groin to the blockage and release a smaller amount of the drug there, sparing the body from possibly bleeding elsewhere.

Interventional radiologists at Mercy say it's a better delivery of the clot-busting drug tPA(tissue plasminogen activator), a "coil” that pulls out clots and a special catheter that shakes clots loose with sound waves.

In April, the American Heart Association/American Stroke Associationreiterated that intravenous tPA delivery is the treatment of choice for stroke. The panel that wrote stroke care guidelines said intra-arterial tPA use and mechanical clot removal show promise but need more research before becoming treatment standards.

"That's true,” said McCollum, an interventional radiologist, "but nothing beats experience.”

Mercy numbers show the treatment can have a dramatic impact on patients being able to return to their lives with their memories and muscle control intact. Since 2001, more than 50 percent of patients treated there within six hours of a stroke recovered in a week or less.

McCollum has a bevy of criteria that determine whether a patient receives intra-arterial or intravenous tPA and whether other tools are used. Those who have recently had surgery, are on blood thinners or have fragile vessels associated with age often are excluded from intravenous drug delivery.

McCollum said intra-arterial delivery allows some of these patients to receive drugs they may not otherwise receive, perhaps saving their lives or sparing them debilitating injury.

The treatment is in its infancy, but McCollum is confident in its potential.

Morgan sees promise in intra-arterial drug delivery. However, he said, "It is the clear recommendation that the treatment of choice for acute ischemic stroke is intravenous tPA.”

The Mercy Health Center method is one of many things to improve stroke care since about a decade ago, when doctors waited for strokes to take their course. The amount of damage to the brain would determine whether a person had a slight facial droop but was able to function or required the round-the-clock care of a nursing home.

"You just kind of crossed your fingers and hoped that their weakness and the result of their stroke wasn't that bad,” said Vance McCollum, a doctor at Mercy Health Center.

Strokes come in two varieties, ischemic and hemorrhagic. Ischemic strokes are the most common and are the result of a clot cutting off blood flow in the brain. Although the clots often come from the heart — heart disease is a risk factor — they can come from anywhere. Hemorrhagic stroke is caused by bleeding in the brain, much like an aneurysm.

Morgan and others who treat stroke patients can recall stories of quick, near-perfect recoveries because of the current drugs and clot removal tools.

"That never happened when I was a young man,” he said.

McCollum spoke of a patient who had a stroke and, within weeks, was able to walk his daughter down the aisle at her wedding.

"We have success stories all the time,” he said.

Felix Kayis one of those patients. A Midwest City physician, Kay knew exactly what was happening when he was watching the 10 p.m. news in August 2006 and suddenly couldn't see. Then he couldn't speak.

He had to shift his weight on his chair to make enough of a sound that his wife, who was working on the computer across the hall, could hear him.

"It's very quick, and it's very sudden, and it scares you,” he said, calling his recovery "almost like a miracle.”

Kay, who insisted on being taken to Mercy Health Center because of the treatment there, had four clots in his brain.

"They had this thing honed down to a T,” said Kay who has fully recovered, still sees patients and enjoys "ski biking” in Colorado. "Time is of the essence.”

Oklahoma ranks second among the 50 states, Washington, D.C., and Puerto Rico in the death rate from cardiovascular disease, according to the journal Circulation. Only Mississippi had a higher death rate.

The state's rates of obesity, poor nutrition, smoking and diabetes all play a role.

Strokes kill 31,000 people in the state annually,

Out of about 600 stroke patients at Mercy last year, 73 met criteria for tPA use.

For Morgan and others on the state stroke task force, getting tPA into patients quickly is more important than getting them transferred to the city. Doctors in community hospitals can be trained to give clot-busters, and the Internet allows radiologists to evaluate CT scans from anywhere.

"You shouldn't have to be in the middle of Oklahoma City to get good care. ... We encourage community hospitals to go ahead and give the drug,” he said.

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