SAN ANTONIO – When someone arrives at the hospital with signs of a stroke, doctors will assess how long the person has been experiencing symptoms. This crucial step helps determine the best course of action. If there is an indication of a clot, medical professionals have several treatment options available, including intravenous (IV) medications to dissolve the clots or a thrombectomy, a procedure designed to physically remove the clot.
The timing of these interventions is critical, as decisions are made based on the time window from when the stroke symptoms likely began. “They have a saying, time is brain. It’s always better to come earlier, like as soon as you can, when you have any stroke symptoms,” said Dr. Sujani Bandela, a vascular neurology specialist at University Health and UT Health San Antonio.
Dr. Bandela co-directs the Comprehensive Stroke Center at University Hospital, overseeing innovative clinical trials aimed at enhancing care for local stroke patients. One of the significant advancements is the extension of the time frame during which IV medications can be administered to dissolve clots.
“Up to just a few months ago, we had four and a half hours as our time window,” Bandela explained. However, many individuals do not recognize the symptoms of a stroke and thus delay seeking medical attention. This gap in awareness underscores the importance of the University Hospital’s recent findings, which suggest a potential extension of the time window for administering IV clot-busting medication to as long as 24 hours.
In addition, a new trial called SELECT LATE focuses on thrombectomies, procedures that remove clots. “Previously, thrombectomies were available within 24 hours of the stroke onset. Recent studies have shown that we can extend this window to as much as 72 hours for specific patient populations,” Bandela noted. University Hospital is one of only three hospitals in Texas participating in this pivotal trial.
To enhance community awareness, Dr. Bandela and her team are actively educating local first responders, including EMS and the San Antonio Fire Department, about these new developments. “We’re in the process of educating multiple groups about it and our ER, and initiating all these because this is brand new information,” she said.
In earlier discussions, Dr. Bandela emphasized the necessity for individuals to be aware of the nearest high-level stroke centers. “Coming to a comprehensive stroke center is unique because we always have someone on-call 24/7, including a stroke neurologist and an endovascular neurosurgeon,” she explained. “We see high volumes, and we have all the necessary equipment and medications, including IV clot-busting drugs. Not every hospital can perform thrombectomies, which are critical in life-threatening situations.”
Comprehensive Stroke Centers represent the highest level of stroke care, classified as Level One. In San Antonio, there are only three such centers: University Hospital, Methodist Hospital, and St. Luke’s Baptist Hospital.
The Southwest Texas Regional Advisory Council (STRAC) website features a stroke resource page that provides information on the status of various local hospitals. Among these, Northeast Baptist Hospital is recognized as an Advanced Stroke Center (Level 2), while at least nine other hospitals in San Antonio are classified as Primary Stroke Centers (Level 3). Additionally, a few centers are designated as Acute Stroke Ready, which represents the lowest level of care.
Dr. Bandela reiterated the importance of recognizing stroke symptoms, highlighting the widely used acronym BE FAST:
Balance: Is there a sudden loss of balance or coordination?
Eyes: Is there sudden trouble seeing in one or both eyes?
Face: Does one side of the face droop or feel numb?
Arms: Does one arm feel weak or numb?
Speech: Is speech slurred or hard to understand?
Time: If you observe any of these symptoms, call emergency services immediately.
To prevent strokes altogether, the American Heart Association recommends avoiding smoking, controlling blood pressure and diabetes, limiting alcohol intake, attending regular check-ups, exercising, and maintaining a healthy diet, such as the Mediterranean diet.
