Monday Medical: Advances in treating strokes
Editor’s Note: This article is part 2 of a 2-part series on stroke. Part 1 focuses on stroke basics.
When it comes to a stroke, every second counts. That’s why UCHealth Yampa Valley Medical Center is using a new medication, Tenecteplase (TNK), to treat ischemic strokes, or strokes in which a blood clot prevents blood from reaching part of the brain.
The new medication replaces Alteplase (tPA), which was the standard treatment for almost three decades. Both medications break up clots to restore blood flow to the brain, but TNK is easier to administer.
Lauren Romanelli, a registered nurse in the emergency department at UCHealth Yampa Valley Medical Center, outlines things to know about this latest change in treatment.
With any stroke symptoms, it’s critical to get treated quickly. When oxygen-rich blood can’t reach the brain, more damage can result with each passing minute.
Additionally, treatments are time-sensitive. If you wait too long, you may no longer qualify.
“The time of getting treatment is limited, so we always encourage people to come in,” Romanelli said. “Air on the side of caution. We would rather it be nothing.”
When someone checks into the Emergency Department with stroke symptoms, the nursing staff follows a clear workflow to quickly determine if a stroke may be involved.
“We do a ‘BE FAST’ exam to see if they check any boxes — balance, facial droop, difficulty with speech, arm weakness — and another assessment to check for visual deficits,” Romanelli said. “Those two screenings help us activate a stroke alert and get the doctor involved.”
A CT scan is taken, and if it shows the stroke hasn’t yet had significant impact to the brain, the patient may be a candidate for receiving medication. The YVMC team also has a process to quickly connect through technology with a neurologist at UCHealth University of Colorado Hospital to assist with examination and treatment steps.
The entire process takes minutes.
“If you present with certain symptoms, our ED team is well-trained to get diagnostics — including labs, vitals and imaging — quickly,” Romanelli said.
For patients who qualify, TNK can help break up clots, restoring blood flow to the impacted portion of the brain.
The new medication is quick to administer: instead of dosing a portion of the medication, then giving the rest through an IV over an hour, it is given all at once in a single dose.
“TNK is a one-time dose,” Romanelli said. “We fly these patients out, weather dependent, and if the flight comes quickly, now we don’t have to transfer the medication to the flight team.”
TNK, which has been used for years to dissolve clots in heart attacks, does come with a risk of bleeding: people who are taking an anti-coagulation medication or who have experienced recent trauma may not be eligible.
The medication also needs to be administered within the first four-and-a-half hours of symptom onset.
“That’s why it’s so important to get the time of symptom onset down to the minute, because we want to make sure we’re appropriately giving this medication,” Romanelli said. “As more time passes since the onset of symptoms, the risk of bleeding with TNK administration increases.”
Clots can be physically removed through a thrombectomy. In this procedure, a skilled radiologist enters a blood vessel in the arm or leg with a catheter, then moves into the brain to pull the clot out or drip clot-busting medicine directly on it.
The procedure can be done within six to 24 hours after the onset of symptoms. This longer treatment window is especially helpful for patients who don’t recognize stroke symptoms right away, such as those who wake up with symptoms.
With treatment, many patients have a good chance of recovering partially or fully.
“If someone can act fast and get to an ED in a timely manner, even if their deficits seem catastrophic at first, people can make great strides in recovery with treatment and rehabilitation,” Romanelli said. “They’ll stop back into the department, and we’ll be shocked at how well they’re doing.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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