Medically Reviewed by Timothy L. Hagen, DO
When treating a stroke, specialists know that “time is brain,” the faster the treatment, the greater the chance of saving a life and avoiding long-term issues. Another new and important concept in stroke treatment is the “tissue clock,” as McLeod Hospital Neurologist Dr. Tim Hagen explains:
Here’s a summary of Dr. Hagen’s comments of the “Tissue Clock:”
One of the concepts that’s new in neurology today is the tissue clock, when it comes to the treatment of acute stroke. What do I mean by that? When you come in with stroke symptoms, we often ask, “What is the time you were last-known well? When were you last normal?”
Then from that point on, the clock starts ticking.
What we have found is that “time is brain” represents an important metric to follow. When we do imaging with a CT scan, we can look at the blood vessels. We can look at the core of the stroke and the threatened portion of the brain affected by the stroke. With this information, we can design a treatment for that specific patient based on their “tissue clock” and we are not constrained by the time clock.
Two recently published studies suggest that you might be given tPA (the clot buster drug) up to 9 hours after the stroke, in contrast to the current standard of care – a limit of 4.5 hours after the stroke. You might say, well how can that be? If you have the right imaging and it suggests that there’s brain to save, then maybe we should start administering tPA. We certainly do that with the thrombectomy. You have up to 24 hours to be considered a thrombectomy candidate, if the tissue clock says there’s brain to salvage.
It’s not yet the standard of care to give tPA at 9 hours after a stroke. One instance in which it might be considered is the so-called “wake-up stroke.” We’ve known for a long time that the wake-up stroke doesn’t let you know when a patient’s last time was when they were well. Was it really when they went to bed at 10:00 last night? Or was it really 2:00 in the morning? Or 3:00 in the morning? And now they’re showing up at the emergency department. It could be that and they’re actually within the window but you don’t know? So that’s why these trials were undertaken.
FIND A STROKE-READY EMERGENCY DEPARTMENT NEAR YOU:
It is important the you know where there is a stroke-ready hospital – one with the accredited expertise and team to provide fast and best treatment.
You can find Stroke-Ready Hospitals in the McLeod system anywhere that McLeod has an Emergency Department. So, if you’re in Dillon, Cheraw, Florence, Seacoast, Loris or Clarendon — all those Emergency Departments are accredited as Acute Stroke Ready, as documented and credentialed by the guidelines of DNV GL Healthcare, a world-leading certification body. DNV GL Healthcare helps their customers achieve excellency by improving quality and patient safety through hospital accreditation.