The significance of timely stroke treatment for improved outcomes

Dr Kok Chin Yong

Dr Kok Chin Yong, Consultant Neurologist and Internal Medicine Physician at Sunway Medical Centre Velocity (SMCV), explains, “Ischaemic strokes can result from various conditions, such as the build-up of fatty deposits in arteries, and many other factors that promote blood clot formation.” Hence, immediate medical attention is crucial to minimise brain damage and improve treatment outcomes and post-stroke recovery.

The Importance of Golden Hour for Stroke Treatment

If a stroke occurs, time is of the essence, and every second counts. The acronym 'BE FAST' is a widely known acronym used to help identify stroke symptoms quickly, but equally important is the concept of 'The Golden Hour'. This term refers to the critical time window from the onset of stroke symptoms to receiving treatment, allowing medical professionals to restore the blood supply to the brain after blood vessels become blocked. During this period, timely medical intervention can significantly improve the chances of recovery and reduce the risk of long-term disability or death, given that around two million brain cells die every minute without blood supply.

Medical interventions during 'The Golden Hour' include two key treatments: thrombolysis and mechanical thrombectomy. Thrombolysis involves administering medication to dissolve smaller blood clots in the brain and must be conducted within 4.5 hours of the stroke onset. This treatment significantly increases the chances of restoring blood flow to the brain and reducing the risk of permanent damage.

For stroke patients with larger blood clots, mechanical thrombectomy would be performed. This procedure involves using a device to physically remove the clot, similar to a heart angioplasty where a Neurointerventional Radiologist will use stent retrievers to expand within the blood clot, allowing the blood clot to be pulled out along with the device aspiration catheters, which is a suction to aspirate the clot directly out of the vessel. Mechanical thrombectomy is most effective within 6 hours of stroke onset but can still be beneficial if performed within 24 hours in certain cases. Dr Rozman Zakaria, Consultant Radiologist and Neurointerventional Radiologist at Sunway Medical Centre Velocity (SMCV), elaborates that mechanical thrombectomy can more thoroughly restore blood flow as it can fully remove the blood clot from the brain, thereby enhancing recovery outcomes.

Dr Rozman also highlights that if stroke patients do not receive treatment within the golden hour, the risk of severe brain damage, increased mortality, and long-term disabilities significantly rises. Delayed treatment reduces the effectiveness of interventions, making recovery more challenging and often resulting in permanent physical, cognitive, and speech impairments. This will definitely impact the quality of life for the stroke survivors, affecting their independence and overall well-being. Thus, immediate medical intervention during this golden hour window is crucial for improving outcomes and reducing these adverse effects.

Studies have also shown that if thrombolysis is conducted within the golden hour window, it increases the likelihood of functional independence of stroke patients by 30% at three months post-stroke, allowing patients to manage their daily activities with less assistance. On the other hand, mechanical thrombectomy can boost independence in nearly 50% of stroke patients and reduces post-stroke symptoms in over 40% patients. Dr Kok also emphasises that both treatments aim to reopen blocked blood vessels and restore brain blood flow, and in some cases, a combination of both may be used to maximise recovery potential.[3]

Photo courtesy of Sunway Medical Centre Velocity

Rehabilitation and Journey to Recovery

Stroke treatment is not only about immediate intervention during the acute phase of stroke but also involves long-term rehabilitation to aid recovery. Dr Kok and Dr Rozman both stress the importance of not giving up on rehabilitation, despite the challenges and stigma associated with it. Rehabilitation aims to maximise recovery through brain neuroplasticity, where the brain forms new connections to compensate for damaged areas.

Dr Kok advises that while it is important to accept the reality of a stroke, patients should remain committed to their recovery. “Rehabilitation can significantly improve the quality of life and independence, reducing the need for assistance in daily activities.” Dr Rozman echoes this sentiment, encouraging all patients to continue with rehabilitation to further improve their physical and cognitive abilities.

In addition to the importance of immediate treatment and rehabilitation, more advanced and innovative treatment strategy such as non-invasive brain stimulation in the form of repetitive transcranial magnetic stimulation (rTMS) is now available and can be utilised to improve the brain neuroplasticity and helping in expediting patients’ recovery trajectory.

Furthermore, daily lifestyle choices and diet are crucial for stroke prevention. Dr Kok shares that being physically active and consuming Omega-3-rich foods and five or more servings of fish per week, can lower stroke risk by 60%. Hypertension and diabetes are key risk factors, as they promote plaque buildup in blood vessels, potentially causing blockages in blood flow to the brain, leading to sudden stroke symptoms.

He also observes an increasing incidence of stroke among younger individuals, often linked to sedentary lifestyle, smoking, undiagnosed hypertension and obstructive sleep apnea (OSA), which is common in overweight individuals and frequently goes unnoticed.

All in all, effective stroke treatment within the golden hour can significantly improve patient outcomes and reduce long-term disabilities. Patients must seek immediate medical attention if they are experiencing stroke symptoms and to continue rehabilitation post-treatment to enhance recovery. Each stroke case also requires a tailored treatment approach, so consulting your trusted medical professionals and physiotherapists is essential.

By understanding the importance of timely treatment during the onset of stroke and knowing the importance of undergoing rehabilitation, stroke patients and their caregivers can take proactive steps to improve their quality of life and independence.

[1] https://www.dosm.gov.my/uploads/release-content/file_20231030100000.pdf

[2]https://www.moh.gov.my/moh/resources/Penerbitan/CPG/CARDIOVASCULAR/CPG_Management_of_Ischaemic_Stroke_3rd_Edition_2020_28.02_.2021_.pdf

[3] https://www.nejm.org/doi/full/10.1056/NEJM199512143332401