SAN ANTONIO – When someone arrives at the hospital with signs of a stroke, doctors will assess how long the person has been having symptoms.
If it seems there is a clot, doctors have some options, including using IV medication to bust clots or doing a thrombectomy, a procedure that pulls a clot out.
Those decisions are made based on the time window from when the patient’s stroke likely started.
“They have a saying, time is brain. It’s always better to come earlier, like as soon as you can, when you have any stroke symptoms,” said Dr. Sujani Bandela, a vascular neurology specialist for University Health and UT Health San Antonio.
Bandela co-directs University Hospital’s Comprehensive Stroke Center, overseeing groundbreaking clinical trials expanding care for local stroke patients.
One of those trials is expanding the time window of when they offer IV medications that break up clots.
“Up to just a few months ago, we had four and a half hours as our time window,” Bandela said.
However, many people don’t recognize the symptoms and don’t get to the hospital soon enough. That’s why what the University Hospital has found is a big deal.
“There was evidence and benefit in pushing that time window for IV clot-busting medication for up to 24 hours,” Bandela said.
Another trial, which just started, is called SELECT LATE, which has to do with thrombectomies, procedures in which doctors remove clots.
“It was available for 24 hours. But with recent studies, they have shown that we have been able to push them out to even 72 hours in some select patient populations,” Bandela said.
University Hospital is one of only three hospitals in the state enrolled in this trial.
Now, they are spreading the word to other local first responders.
“We’re in the process of like educating multiple groups about it and our EMS, San Antonio Fire Department, our ER, and initiating all these because this is brand new information,” Bandela said.
In previous reporting, Bandela explained why it’s important for people to know which high-level stroke centers are around them.
“Coming to a comprehensive stroke center is unique because we always have somebody 24/7, an on-call stroke neurologist, an on-call endovascular neurosurgeon, nurses, Bandela said. “We see high volumes, and we have all the equipment and medications, the IV clot-busting medication. Not every hospital has the suites to do the thrombectomies, the procedures to remove clots. And those are the potentially life-threatening one.”
Comprehensive Stroke Centers are the highest level of stroke care: Level One. There are only three in San Antonio, all three in the Medical Center: University Hospital, Methodist Hospital, and St. Luke’s Baptist Hospital.
The Southwest Texas Regional Advisory Council (STRAC) website has a stroke resource page that lists the status of many local hospitals.
Below is a comprehensive list of an Advanced Stroke Center (Level 2), and the only San Antonio center listed at that level is Northeast Baptist Hospital.
The next level down is Primary Stroke Center (Level 3), and STRAC lists at least nine hospitals in San Antonio.
Then there are a few centers labeled Acute Stroke Ready, the lowest level.
Bandela said the most important thing to know ahead of time is what symptoms to look for that may signal a stroke.
The popularly used acronym is BE FAST:
- B — Balance loss
- E — Eyesight changes
- F — Face drooping
- A — Arm weakness
- S — Speech difficulty
- T — Time to call 911 immediately
To prevent stroke altogether, the American Heart Association recommends avoiding smoking, controlling blood pressure and diabetes, limiting alcohol, going to doctor checkups, exercising, and eating less processed food by maintaining a healthy diet, such as the Mediterranean diet.
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