Stroke: A Major Medical Emergency
Stroke is a medical emergency that occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. A stroke is a serious life-threatening medical condition that requires immediate medical attention.
Georgia is in the Stroke Belt:
Stroke is a very serious health problem in Georgia. It’s the fifth most common cause of Georgia deaths, and also a major cause of disability in Georgia. The scary part is that a stroke can happen to anyone, regardless of age.
Georgia is part of what’s called the ‘stroke belt.’ This is an area stretching across the southeastern United States that has 30 percent higher stroke death rates compared to the rest of the country. Even worse, the coastal plains of Georgia are in the buckle of this ‘belt,’ where stroke death rates are about 40 percent higher than the national average.
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The Importance of tPA
The majority of strokes are caused by a blood clot that blocks the flow of blood through vessels in the brain (called ischemic strokes). The clot-busting drug known as tissue plasminogen activator (tPA) is an effective treatment for this type of stroke. tPA works by dissolving the clot and reopening the flow of blood to the part of the brain being deprived of blood flow and oxygen. One study reported that with a middle cerebral artery stroke (a common type) the patient’s brain will lose approximately 120 million neurons for every hour the blood clot is allowed to remain in place.
The timely administration of tPA can significantly reduce the effects of a stroke and substantially improve recovery outcomes if given promptly after stroke symptoms start.
Timing is Crucial – Time Lost is Brain Lost
The timing of administering tPA is extremely critical, and needless delay is often the basis of stroke care medical malpractice claims. To be effective, tPA must be given within a 4.5-hour window from the onset of stroke symptoms. Once that time window is closed, tPA may not be given because it can do more harm than good because of changes that have already occurred to the brain. This narrow time frame is often referred to as the ‘golden hour’ in stroke treatment (even though technically it is 4.5 hours). The sooner the drug is administered within this window, the better the outcomes usually are for the patient. So, you never want to wait to give tPA at the end of the time window, ideally if you could, you would give tPA within the first few minutes of the start of symptoms.
Qualifications for Receiving tPA
Not every stroke patient is a candidate for tPA. The drug is typically given to patients who:
- Are having a stroke caused by a blood clot (ischemic stroke).
- Are within the 4.5-hour window from the onset of symptoms.
- Have no contraindications, such as recent surgery, bleeding disorders, or a history of intracranial hemorrhage.
The Role of Thrombectomy
In addition to drug therapy, a relatively new procedure called thrombectomy can be performed to mechanically retrieve a clot from a blood vessel in the brain during an acute ischemic stroke. Thrombectomy is usually considered for patients with a clot in a large artery, and it can be performed up to 24 hours after stroke symptom onset, thus extending the treatment window well beyond that of tPA. However, just like with tPA, doctors want to perform a thrombectomy and remove the clot as soon as possible after the onset of symptoms.
Timely Performance of Thrombectomies
The rapid performance of a thrombectomy is crucial to the patient’s outcome. The procedure should always be performed as soon as possible because, similar to tPA, the benefits of thrombectomy decrease as time passes. Because tPA has been used for many years now, doctors are getting better at the rapid use of tPA. Unfortunately, when tPA fails to dissolve the clot, or the patient is ineligible for tPA, doctors still often fail to recognize which patients should receive a thrombectomy to remove the clot. Thrombectomies are performed by neurosurgeons or interventional radiologists, and not all hospitals have doctors on staff who can perform them. If hospitals do not have qualified doctors who can perform a thrombectomy, their duty to the patent is to arrange for emergency medical transportation of the patient to the nearest hospital that can perform it. Patients who are eligible for thrombectomy typically have:
- A confirmed diagnosis of ischemic stroke with a large vessel occlusion.
- A small amount of damaged brain tissue at that point in time, but a larger area of brain tissue at risk of damage.
- No significant medical contraindications to the procedure.
Stroke Malpractice Claims
In Georgia, the failure to quickly administer tPA to eligible patients, or the failure to perform emergency thrombectomy procedures for eligible patients, is the basis for a growing number of medical malpractice lawsuits due to the devastating injuries that can occur. It is essential for medical professionals to act swiftly and appropriately to maximize the chances of a positive outcome for stroke patients.
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