Hospital studies result in expanded stroke treatment window

Two national studies increased the treatment window from six hours to 24, a potential life-saver for people who have strokes during sleep

By David Wahlberg
The Wisconsin State Journal

MADISON, Wis. — When Kent Wittwer couldn’t wake up his wife last month, he called 911.

Jill Wittwer, 59, was rushed to UW Hospital, where doctors said she had a stroke. Using a stent device inside a catheter, they removed a clot blocking blood flow in her brain.

Until recently, patients couldn’t get the procedure unless doctors knew the stroke happened within six hours. But two national studies, one involving patients at UW Hospital, expanded the window to 24 hours — a potential life-saver for people who have strokes during sleep, as Wittwer did.

“Even though things didn’t look good, there can be a good outcome,” Kent Wittwer said.

About 795,000 Americans have strokes each year and about 140,000 die, with many others left disabled. The vast majority of strokes are caused by clots, while others stem from ruptured blood vessels in the brain.

For strokes involving clots, the first-line treatment is alteplase, or tPA, a drug given intravenously to dissolve the blockages. But the drug must be given within 4.5 hours of a stroke, and it rarely clears clots fully from large blood vessels.

In a procedure called a thrombectomy, for clots in large blood vessels, doctors thread a catheter through the vessels and use a stent to grab the clots and pull them out.

The treatment window was six hours until the two studies, published recently in the New England Journal of Medicine, showed the procedure can be worth trying up to 24 hours after a stroke.

The American Stroke Association announced the new guideline in January.

“The expanded time window for mechanical thrombectomy for appropriate patients will allow us to help more patients lower their risk of disability from stroke,” Dr. William Powers, a neurologist at the University of North Carolina-Chapel Hill, who helped write the guideline, said in a statement.

New software used with CT scans allows doctors to see parts of the brain harmed by strokes and undamaged areas potentially salvageable through thrombectomy.

“We use imaging to help us identify who still has brain that’s viable, that we can still save,” said Dr. Azam Ahmed, a neurosurgeon at UW Health who operated on Wittwer and oversaw UW Hospital’s participation in one of the two studies.

“The time (window), in and of itself, doesn’t matter as much as making sure there’s viable brain to save,” Ahmed said.

UW Health’s telestroke program, involving nine community hospitals from central Wisconsin to northern Illinois, can help patients at those hospitals get treated with the clot-busting drug on site or transferred to UW Hospital for other care, including thrombectomies.

The new guideline applies to clots in blood vessels in the front of the brain. Wittwer’s stroke was near the back of her brain, but the general idea of expanding the time window relates to those strokes too, Ahmed said.

Wittwer and her husband, who live south of Belleville, went to bed about 9 p.m. on Friday, Feb. 23.

About 7 a.m. the next day, Kent Wittwer got up, but Jill Wittwer still appeared to be sleeping. Two and a half hours later, he tried to wake her but couldn’t.

An ambulance took her to UW Hospital, where she had a thrombectomy that afternoon — outside of the old treatment interval of six hours, but within the new interval of 24 hours.

Wittwer spent four days in the hospital and five days in a rehab facility. She had double vision and moved slowly at first, and still has some trouble thinking.

But she is recovering and eager to return to her job as a medical assistant at UW Health’s sports medicine clinic at University Research Park, she said.

“I’m a little delayed yet, slow,” she told Kari Esser, a speech language pathologist, at an appointment last week. “I’m tired, but I’ll make it.”

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