Co-author of Rules for Emergency Stroke Care | News | Loyola Medicine
Monday, January 29, 2018

Loyola Neurologist is Co-author of New Guidelines for Emergency Stroke Care

brain scans showing stroke

MAYWOOD, IL –  Loyola Medicine neurologist José Biller, MD, is a co-author of new national guidelines for treating stroke patients during the critical first hours after a stroke.

The guidelines, issued by the American Heart Association/American Stroke Association, are published in the association's journal Stroke.
 
In a video posted on the association's website, Dr. Biller explains two of the most important points of the guidelines:
  • More stroke patients now will be able to benefit from a clot-busting drug called alteplase, when administered during the first 4½ hours of the onset of a stroke.
  • In certain patients, mechanically removing blood clots to restore blood flow in the brain can be effective for up to 24 hours after the stroke's onset. In previous guidelines, the treatment window was six hours.
Dr. Biller, chair of Loyola's department of neurology, is an internationally known expert on stroke care.
 
The guidelines apply to ischemic strokes, which account for about 85 percent of all strokes. An ischemic stroke typically is caused by a blood clot that blocks blood flow to a region of the brain. Without blood supply, brain cells begin to die. Timely treatment to remove the clot and restore blood flow can minimize stroke damage.
 
One treatment involves intravenous administration of alteplase (also known as tPA), which can dissolve clots. The new guidelines broaden treatment criteria to include select patients with mild strokes, who previously were not eligible for this treatment. Doctors should weigh the risks and benefits in individual patients.
 
A second treatment is a procedure called mechanical thrombectomy that physically removes the clot. The physician inserts a catheter in the patient's groin and guides the thin tube through various blood vessels up to the brain. Once the catheter reaches the blockage, the physician deploys a device through the catheter that removes the clot, either by grabbing and pulling it out or suctioning it out.
 
Mechanical thrombectomy is indicated for clots blocking large blood vessels. The new guidelines say the procedure can be done as long as 16 hours after a stroke in selected patients. Under certain conditions, based on advanced brain imaging, the time window can be extended to 24 hours.
 
The guidelines also recommend "telestroke" programs for hospitals that don't have access to neurologists or emergency room doctors trained to use the clot-busting drug. Such programs use real-time videoconferencing to connect hospitals to stroke experts. Research shows that telestroke patients receive the same quality of care as if they were treated at a stroke center with a neurologist on call.
 
Loyola Medicine operates a growing telestroke network that serves 10 centers in Illinois, Indiana and Iowa. Loyola stroke specialists are on call 24/7 to examine patients remotely and recommend treatments to physicians at the bedside.
 
One critical guideline has not changed: The recommendation for fast action when a person first shows stroke symptoms.
 
"Time is brain," Dr. Biller said. "In the right patient, treatment with a clot-busting drug or mechanical thrombectomy has the potential to significantly limit stroke damage. Every effort should be made to treat these patients as early as possible with a multidisciplinary and integrated team of experts."
 
A simple way to remember the signs of a stroke is to think of the word FAST:

F – Face drooping: Does one side of the face droop or is it numb? Ask the person to smile.
A – Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
S – Speech difficulty: Is speech slurred, are they unable to speak or are they hard to understand?
T – Time to call 911. If the person shows any if these symptoms, even if the symptoms go away, call 911 and bring them to the hospital immediately.

The new guidelines are titled, "2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association."
 
The guidelines writing group was chaired by neurologist William J. Powers, MD, of the University of North Carolina in Chapel Hill.
 
Loyola's Stroke Center includes a nationally recognized team of experts in every facet of stroke-related care, including neurology, neurosurgery, neuroradiology, emergency medicine, rehabilitative services, social work, pharmacy and specialized neuroscience nursing.
 
Loyola is among an elite group of hospitals nationwide to be certified by The Joint Commission as a comprehensive stroke center. For nine years in a row, Loyola has received the American Heart Association/American Stroke Association's Get With The Guidelines® - Stroke Gold Plus Quality Achievement Award. The award recognizes Loyola's commitment to providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.  
 

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.