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To benefit from new stroke drugs, getting to the emergency room immediately after a stroke is essential   

In the United States, on average, someone suffers a stroke every 53 seconds. Every 3.3 minutes someone dies from stroke, also called brain attack or cerebrovascular occlusion. Not all victims of stroke are senior citizens. Of the 600,000 stroke victims each year, 28 percent are under the age of 65.

The most common form of stroke, called ischemic stroke, occurs when a blood vessel in the brain becomes clogged with fat or cholesterol (cerebral thrombosis) or a blood clot (cerebral embolism). Brain cells are starved of life-supporting oxygen and begin to die. Various body functions die with them, from speech to vision. Ischemic strokes account for 85 percent of all strokes.

In the US, 4.4 million stroke victims are alive today. One of them, someone you wouldn’t think could have had a stroke, is 36 year old Cortez Lancaster. He discovered one morning that he couldn’t move his hand: “It feels like my whole body’s not working properly. It’s harder now for me to get dressed, to button my clothes. A lot of stuff I have to compensate for like my shoes. I can’t buy laced up tennis shoes.”

Cortez Lancaster’s stroke at age 36 left his left side partially paralyzed

There’s a chance Cortez could have avoided the debilitating effects of stroke had he been treated immediately after his stroke began with a pharmacological breakthrough of the nineties, a drug called Tissue Plasminogen Activator (t-PA). The medication, tested in the early 1990’s and released in 1996, breaks up blood clots. These so-called thrombolytic agents stop artery blockage in the brain, saving brain nerve damage and related functions. t-PA, which is only for ischemic stroke, not hemorrhagic stroke, is only highly effective if administered promptly and appropriately, that is, within three hours of a stroke or the onset of stroke symptoms. Stoke sufferers who are given t-PA properly are thirty percent more likely to have little or no disability compared to patients who do not receive t-PA.

The tight time frame for the drug’s effectiveness, and lack of awareness about the drug, are limiting its benefits to just a small percentage of the millions of stroke victims who need it. In the next few years an American Heart Association campaign called “Operation Stroke... Chain of Recovery” will educate emergency personnel and the general public about the significant benefits of Tissue Plasminogen Activator.

Dennis Landis, MD, Chief of Neurology, University Hospitals of Cleveland, says too few know about this remarkable stroke therapy: “It is such an obviously good therapy that we thought it would be taken advantage of and made available across the country. That has not happened. It’s discouraging. The estimates are that now between only one and two percent of people who could benefit from this therapy in fact receive it.”

Stroke-trained hospital staff can identify, test, and treat stroke victims with appropriate urgency.

Anthony Furlan, MD, Director, Cerebrovascular Center, Cleveland Clinic, says timing is paramount for t-PA’s benefits: “The patients just don’t get to the hospital on time. t-PA has to be given within three hours of stroke onset, so by the time the patient recognizes they’ve had a stroke, calls 911, gets to a hospital, [does] all the things that have to be done in the hospital, sees the doctor, gets a CAT scan... three hours may have evaporated.”

Sponsors of “Operation Stroke... Chain of Recovery” believe hospitals need to orient and organize for treating stroke with t-PA. There are treatment risks, specifically a six percent chance of brain hemorrhage, so doctors need to be trained to select only suitable patients. Education and preparedness are the keys. Dr. Furlan thinks too few hospitals have a stroke plan, the way they do for heart attacks: “This doesn’t just happen. Your systems have to be in place, they have to be organized. I mean we run into things like the elevator is not available and the patients can’t get to the CAT scanner on time and for a reason like that they can’t get t-PA.”

Money is not a factor with t-PA treatment: the drug is relatively inexpensive. It can save huge costs later, bills that people like Cortez Lancaster face in rehabilitation. According to the American Heart Association, stroke costs add up to $40 billion a year in health care and lost productivity. An average hospital bill for stroke is around $18,000.

As for the rush to administer t-PA, the clock starts ticking with the response of the stroke victim to the initial symptoms of stroke. In the quest to reduce cardiovascular disease by 25 percent by 2008, the American Heart Association is stepping up its efforts to educate the public on the warning signs of stroke and mini-strokes called TIA’s, transient ischemic attacks. The aim is to provide the best care available with minimum delay.