New Treatments in Stroke Prevention

In 2016, the CDC ranked Arkansas first in the U.S. in stroke-related deaths. The most recent rankings (2021) reveal that Arkansas has improved to 21st nationally. Much of this improvement can be attributed to renewed focus among statewide leaders over nearly a decade. The governor began focusing funding efforts on preventing stroke deaths. The Arkansas Department of Health created a division focusing on stroke prevention. The University of Arkansas for Medical Sciences began partnering with hospitals across the state to identify stroke symptoms via telehealth and recommending new medications to treat stroke, including a recently FDA-approved drug called Tenecteplase.

Jeremy Stogner, Assistant Director of the Emergency Department and Stroke Outcomes Coordinator for the Arkansas Heart Hospital, has learned new technology and drugs being used to decrease stroke deaths statewide.

Tenecteplase

One new drug, Tenecteplase, has decreased treatment time for stroke victims. “Many hospitals across the state are switching to using Tenecteplase,” Jeremy says. “It’s a clot-buster drug, just like Alteplase, but it is cheaper and much faster to administer.” Alteplase has been the drug of choice for “intravenous thrombolysis” since the 1990s, but it has had its fair share of setbacks. Tenecteplase, a more recent, genetically engineered clot-busting drug, has proven to be a quicker and more efficient alternative to Alteplase.

Tenecteplase, a more recent, genetically engineered clot-busting drug, has proven to be a quicker and more efficient alternative to Alteplase.

The biggest criticism of Alteplase has been the method of drug administration, which is open to errors and delays, which can be catastrophic in emergency settings. “Tenecteplase is cheaper and quicker to administer than Alteplase, so it’s become the most widely-accepted alternative,” Jeremy says. “With Tenecteplase, you can just use an IV push and be done. Tenecteplase takes around five seconds to administer a full dosage, whereas Alteplase is usually administered over an hour.” A patient must receive a dosage of Tenecteplase within the American Heart Association’s recommended 4.5-hour treatment window for the dosage to be most effective. “After 4.5 hours, the risk is too high to administer dosages of either drug,” Jeremy says.

ApTOLL

While still being studied, new research into ApTOLL has shown promising results in shielding the brain from tissue damage. At the American Stroke Association’s International Stroke Conference in February, AHA announced that ApTOLL has been linked to “reduced death and disability among people being treated for stroke when used with standard treatment to restore blood flow.” The clinical trial found that higher ApTOLL dosage revealed a neuroprotective effect while lower doses did not show any effect compared to placebo. Ninety days after treatment, participants who received higher doses of ApTOLL had four times lower death rates compared to those who received the placebo. This new study seems promising and could be a huge advancement in stroke-related death prevention across the U.S., where, according to 2023 AHA statistics, stroke remains the fifth-leading case and a major cause of long-term disability.

Other Advancements

The University of Arkansas for Medical Sciences, Baptist Health, and CHI St. Vincent provide comprehensive stroke care in the state, including neuro-interventions to treat stroke victims. “With neuro-interventions, they can use machines that go in, find the clot, and actually pull it out,” Jeremy says. “The treatment can be done within 24 hours of symptom onset. This method has also been very successful in treating strokes.”

An increased focus on providing education to paramedics and EMTs across the state has allowed for the early identification of stroke patients and alert the receiving emergency room to be prepared to rapidly intervene once a stroke victim arrives. Often this means bypassing the emergency department initially and transporting the patient directly to CAT scan. This is an attempt to decrease the amount of time before definitive treatment.

A LIfesaving Acronym to Recognize Stroke Warning Signs

May is National Stroke Awareness Month, a great time to revisit stroke prevention measures you can take in your clinic. Understanding stroke warning signs and responding quickly are the most vital components to saving someone’s life who is experiencing a stroke. Time is of the essence. To quickly remember stroke symptoms and actions you can take if you see someone experiencing a stroke, Jeremy recommends using the mnemonic BE-FAST.

“BE-FAST stands for Balance, Eyes, Face, Arms, Speech, and Time,” Jeremy says. “When we educate people on recognizing warning signs, we always go back to the BE-FAST acronym.”

• Balance: Has the person experienced a sudden loss of balance? Are they leaning to one side or stumbling when they walk?
• Eyes: Does the person mention a sudden loss of vision in one or both eyes? If their double vision doesn’t go away when they blink both eyes, they may be experiencing a stroke.
• Face: When the person smiles or sticks out their tongue, is their smile uneven? Is their tongue stuck on one side? Is one side of their face drooping? Are they drooling?
• Arms: Can the person raise both arms? Is there a sudden loss of coordination, numbness, or weakness in one arm? An example might be that a person can no longer lift a remote or a coffee cup. Does their arm or leg feel numb, or do they complain of having to shake their arm or leg to wake it up?
• Speech: Are you suddenly having trouble understanding the person? Are they having trouble speaking? Can they repeat a simple phrase back to you? When the person talks, is their speech jumbled or slurred? Does the person say they are having difficulty swallowing?
• Time: If the person is experiencing any of these signs, it’s time to call 911. It is best not to drive the person to the emergency room but to call EMS instead. EMS will be able to go through assessment and treatment processes prior to arriving at the Emergency Department. This will save time. When speaking with EMS, it is best to also share the time the patient last saw their doctor and any current medications they are taking, if known. This will help EMS determine what treatments the patient may be eligible for.

A quick response could save a life. If you think you or someone you know is having a stroke, BE-FAST — call 911.

The Arkansas Heart Hospital provides heart health resources with information about cardiovascular disease and choices patients can make to improve their heart health. The heart health resources also provide information about risk factors and additional handouts and guides providers can recommend to their patients who are at increased risk of cardiovascular disease.

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