Stroke treatment: Remember FAST to receive prompt care

Stroke is the leading cause of serious disability and the fifth leading cause of death in adults in the United States. The majority – 80 percent -- of strokes are ischemic strokes, which occur when a blood vessel to the brain is blocked, preventing the brain from receiving the nutrient-rich oxygenated blood it needs to function.

Signs of a stroke

Knowing stroke symptoms is the most critical step to receiving prompt treatment. The acronym FAST can help you remember the warning signs of a stroke:

• Facial drooping on one side
• Arm weakness on one side
• Speech difficulty: trouble speaking, slurred speech or incorrect speech
• Time to call 911 if you have any of these symptoms because it might mean a stroke is taking place

Get fast treatment for improved stroke recovery

The most important and effective stroke treatments are those that reopen the blocked artery and restore blood flow to the brain. Every minute that goes by before blood flow is restored results in the death of two million nerve cells. To prevent permanent damage, treatment usually has to occur within the first one to three hours after stroke onset. There are two main treatments that reopen blocked arteries:

• Clot-dissolving drugs: A tissue plasminogen activator, TPA, dissolves the blockage that caused the stroke. It works like the chemicals used to unclog drains — they break down the build-up so blood can flow freely.
• Clot removal devices: Doctors thread a wire through an artery in the leg and advance it to the brain. Attached to the wire is a pincer or suction device that can grab the clot and pull it out. Using the drain analogy, this is similar to a rotary device thread into a drain to capture the clog and pull it out, which improves flow.

New stroke medicines on the horizon

Paramedics can’t give TPA in an ambulance since the drug is only for blood clot (ischemic) strokes and it’s impossible to know what kind of stroke a patient is having without a CT scan or MRI. While 80 percent of strokes are ischemic, the remaining 20 percent are caused by a ruptured blood vessel in the brain (hemorrhagic stroke). TPA is harmful to hemorrhagic strokes.

Because of this limitation and the life-saving importance of time, scientists are using clinical trials to investigate a new class of drugs called neuroprotective drugs, which:

• Allow nerve cells to tolerate low blood flow longer by blocking cell injury if they don’t get enough oxygen.
• Can be given by emergency responders because they should be safe and possibly helpful for both ischemic and hemorrhagic strokes.

Enrolling in a stroke clinical trial

UCLA researchers are enrolling patients in a clinical tria(Link opens in new window)l to study neuroprotective drugs. Qualified patients will:

• Have weakness on one side of the body
• Be between the ages of 40 and 95
• Have symptoms that started within the past 15 to 120 minutes

If you qualify, a paramedic or a doctor (via telemedicine) will ask you or your guardian for permission to enroll while the ambulance transports you to the hospital. When you are enrolled in the study, you’ll:

• Receive all standard treatments for stroke
• Be randomly assigned to also receive a neuroprotective drug or placebo in a one-time injection in the ambulance
• Undergo brief five-minute exams on arrival, then again at 24 hours, two days and four days in the hospital (plus short follow-up phone and in-person visits one and three months after the stroke)

The UCLA Stroke Center(Link opens in new window) offers a stroke risk calculator(Link opens in new window) to help you know your stroke risk. We are recognized as one of the world’s leading centers for the treatment of stroke and related conditions.