Shattering the Six-hour Stopwatch

The American Heart Association’s evidence-based guideline for the early management of patients with acute ischemic stroke covers the selection of eligible patients for endovascular therapy with a mechanical thrombectomy within six hours of what health care workers call the last known normal.

Since the published guideline’s last update in 2015, however, clinical trials of two additional studies have demonstrated that some patients can benefit from the procedure more than six hours and possibly up to 24 hours following a stroke

“Emergency nurses are on the cutting edge of identifying stroke patients who were previously considered outside the window of tPA and/or thrombectomy treatment. It is imperative that the ED nurse recognize these stroke patients as quickly as possible,” presenter Patrice Callagy of Belmont, California, said Wednesday during her session “The New DAWN for Stroke Patients.”

The expansion of the window from six to 24 hours provides greater opportunity to get a CT scan using new software that illustrates a patient’s actual stroke versus tissue at risk. By seeing the two states, medical teams can potentially stop a stroke before it happens or minimize the damage by administering a thrombectomy.

“Stroke progression is variable [among patients],” said co-presenter Eric Bernier. He shared two case studies that showed the same type of clot, where one was slow progressing over 11 hours while the other was three hours. In both cases, the expanded window for LKN made the difference between complete recovery and the need for long term care.

Both Bernier and Callagy agreed the key is for emergency departments to rapidly identify first that it is a neurological condition and second that it possibly could be a stroke. Sometimes, patients present with vision issues that could lead teams to consider other conditions, burning valuable time for diagnosis, Callagy said.

“Recognition and treatment within 24 hours will significantly decrease the disability and mortality rate for these patients,” Callagy said.

Thanks to the new stroke window, “we can treat double the number of patients as well as treat patients far away,” Bernier said. “It completely shatters the six-hour stopwatch.”