Stroke experts on why seeking help within the Golden Hour is important

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Currently, there has been a rise in the number of younger individuals affected by strokes who are able to receive timely treatment within four hours after onset. This is attributed to an increased understanding and recognition of this potentially fatal condition. Stress, smoking and alcohol, obesity, and blockages in major blood vessels are among the possible factors contributing to strokes. It is imperative that we acknowledge stroke symptoms using BEFAST (Balance, Eyes, Face Drooping, Arm Weakness, Speech Difficulty, and Time to call emergency services) and work towards improving patients' quality of life.

Patient Sachin aged 30 (name changed) weighing 120 kg, an investment banking professional, and his wife, were filled with joy as they awaited the arrival of their first child. In September, the patient decided to join a gym to lose some weight. Unfortunately, this led to neck pain, dizziness, and vomiting, prompting him to seek medical advice from a local doctor.

The patient's decision to suddenly lift heavy weights and twist his neck resulted in a vertebral artery dissection - a potentially life-threatening condition where the artery wall tears and blood clots form. He was recommended Mechanical Thrombectomy for Vertebrobasilar Junction artery occlusion. Fortunately, his condition improved and he was discharged after one week. During a follow-up appointment with me, the patient arrived with some assistance while walking. It is crucial to understand that there are numerous younger patients like him who are battling strokes and fighting for their lives. Recognising the significance of the golden period - when immediate medical attention can make all the difference - is essential in ensuring positive outcomes for these patients.

A stroke is a medical emergency that occurs when there is a disruption in blood flow to the brain. This interruption can be caused by either a blockage or the rupture of a blood vessel, cutting off oxygen and nutrients to brain cells. The consequences can be devastating, with immediate symptoms such as sudden numbness or weakness on one side of the body, difficulty speaking or understanding speech, and confusion.

There are various factors that can contribute to strokes in young people. One significant factor is having an underlying medical condition such as high blood pressure or diabetes, which puts stress on the blood vessels and increases the risk of clot formation. Additionally, lifestyle choices play a crucial role; stress, excessive smoking, drug use, and alcohol abuse can lead to a stroke.

"Those patients seeking treatment within the window period of four hours can receive thrombolysis and up to 6-12 hours of Mechanical Thrombectomy in a meticulous manner. There is a surge in the number of patients with stroke and large vessel occlusion who receive Mechanical Thrombectomy. At a given hospital there are in-house MRI facilities, and the availability of thrombolytic agents in the emergency room, and the treatment is initiated within 1 hour of arrival to the hospital. It is possible for the patient to recover under four hours. Within the past year, there has been a consistent influx of about 100 stroke patients under the age of 40 and even 30 who experience sudden paralysis due to stroke, resulting in complete one-sided weakness. Each month, approximately 20-25 stroke patients seek medical attention, with 5-7 undergoing thrombolysis and 2-3 undergoing mechanical thrombectomy. In September, there was a notable increase in mechanical thrombectomies performed, reaching approximately seven procedures including three on a single day on September 3. Stroke can lead to disability, and dependency on family members as one will not be able to do the daily activities with ease. Door-to-needle time((DTN)) is less than an hour as treatment initiation occurs," says Dr Pavan Pai, consultant neurologist and stroke specialist, Wockhardt Hospitals, Mira Road

"The golden hour holds immense significance for patients suffering from strokes since each minute plays a crucial role in determining their long-term prognosis. It is life-saving and this critical period necessitates immediate medical intervention to prevent additional harm to the brain and enhance prospects of recovery. It helps with timely administration of clot-dissolving medications like tissue plasminogen activator (TPA). By averting delays in diagnosis and treatment, stroke patients significantly amplify their chances of recovering lost functionality and averting further complications associated with strokes. Only 10 to 20 per cent of people reach the hospital in golden hour. Mechanical thrombectomy is needed in almost 10-20 per cent of cases," says Dr Girish Soni, neurologist, Lilavati Hospital.

Pai adds, "Mechanical thrombectomy is a minimally invasive procedure used to remove blood clots that are blocking large blood vessels in the brain. It involves inserting a catheter into the affected artery and using a device called a stent retriever to physically remove the clot. This procedure has revolutionised the treatment of certain types of strokes, such as ischemic strokes, by restoring blood flow to the brain and preventing further damage. One of the major benefits of mechanical thrombectomy is its ability to significantly improve patient outcomes as the patient has the chance of recovering fully. Additionally, mechanical thrombectomy reduces the risk of complications associated with other treatments for stroke, such as intravenous clot-busting medications. It also reduces the burden on caregivers and improves overall quality of life for individuals who would otherwise be left with severe disabilities after having a stroke."

Soni adds, "Mechanical thrombectomy has revolutionised the treatment options available for stroke patients. One key advantage is its effectiveness in rapidly restoring blood flow to the brain. By directly removing the clot causing the stroke, mechanical thrombectomy significantly reduces the time it takes to reestablish circulation and minimizes potential damage to brain tissue. This results in improved functional outcomes and a higher chance of survival for patients. Another advantage of mechanical thrombectomy is its potential for use within an extended time window. While traditional treatments like intravenous thrombolysis must be administered within a specific time frame after symptom onset, mechanical thrombectomy can be performed up to 24 hours later in selected cases. This opens up treatment options for patients who may have initially been ineligible due to delays in reaching the golden period after stroke. "

The aftermath of a stroke can be immensely challenging, both physically and emotionally, and it is crucial for these individuals to receive the necessary support and treatment. This includes comprehensive rehabilitation programs that address the physical impairments caused by the stroke, such as difficulties with movement, balance, and coordination.