UW Today

January 12, 2011

Think ‘FAST to save lives by recognizing warning signs of stroke

UW Health Sciences/UW Medicine

Check your stroke risk at Power to End Stroke.

Get info on UW Medicine’s Stroke Center.

Visit UW Medicine’s Neuroscience Institute.

UW Medicine neurosurgeon Dr. Anthony Avellino is working to increase public awareness of stroke.

UW Medicine neurosurgeon Dr. Anthony Avellino is working to increase public awareness of stroke.

A stroke or “brain attack” occurs when blood flow in a part of the brain is disrupted. About 80 percent of stroke cases involve an “ischemic” stroke, which occurs when arteries that supply blood to the brain are blocked. The rest are “hemorrhagic” strokes, which occur when a blood vessel in or around the brain bursts.

While hemorrhagic strokes require intensive care for bleeding and possibly surgery, ischemic strokes can be treated effectively in many cases with a strong clot-busting medication known as tPA (tissue plasminogen activator). The key, however, is that treatment must be started within four and a half hours of the onset of symptoms. An endovascular procedure using a catheter to insert a clot retriever, which captures and removes the clot, is time sensitive and must be performed during the first eight hours or as soon as possible after a stroke.

Getting patients to the right place for stroke treatments in time is the goal of recent legislative action to establish the Washington State Emergency Cardiac and Stroke System, which is expected to be operational in July 2011. Patterned after the states trauma system, the new system is expected to save lives and reduce disability for heart attack, cardiac arrest and stroke patients. The goal for stroke victims is to begin tPA treatment in less than 60 minutes from hospital arrival. The system will ensure that emergency medical providers have standard procedures to assess and triage these patients in the field, and it will direct them to the closest hospitals that can provide appropriate care.

Another goal of the new system is to improve public awareness of stroke symptoms with the easy-to-remember acronym “FAST” (Face, Arm, Speech and Time). If you suspect a stroke, ask the person to smile to check for one-sided facial weakness or drooping, raise both arms to see if one falls down or cannot be raised, and speak a simple sentence to listen for slurring or confusion of words. If any of these signs are present, call 9-1-1 immediately and note the time so that this information will be available when the patient arrives at the hospital.

Our states approach to emergency stroke care goes hand-in-hand with a national campaign launched in February 2010 by the American Heart Association/American Stroke Association. The goal of “Target: Stroke” is to achieve “door-to-needle” times of 60 minutes or less for the administration of tPA to eligible patients. It includes an honor roll to recognize hospitals that consistently achieve time targets for emergency stroke care. In November, the UW Medicine Stroke Center at Harborview Medical Center became the first hospital in our state to achieve this recognition.

Even with the best system for emergency care, a growing concern is that the age group at highest risk for heart disease and stroke, people 65 and older, is expected to nearly double by 2030. In addition to atherosclerosis, the buildup of plaque inside blood vessels associated with the aging process, other risk factors for stroke include high blood pressure, tobacco use, diabetes and obesity. It is particularly alarming that nearly 27 percent of our states citizens are obese.

You can check your own risk of stroke with the personal assessment tool on the “Power to End Stroke” website, http://powertoendstroke.org. Whether it is high or low, the first line of defense is prevention. In case your New Years resolutions do not include a healthy lifestyle, lowering your risk for heart disease and stroke is one more reason to stay active, maintain a normal weight and refrain from smoking. 

Anthony M. Avellino is director of the UW Medicine Neurosciences Institute, UW professor of neurological surgery, and joint professor of orthopedics and sports medicine. For more information on the UW Medicine Stroke Center at Harborview, call (206) 744-3975 or visit www.uwmedicine.org/stroke.