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St. Clair Checkup: Time is Brain

Maria Abraham, MPAS, PA-C

In January 2020, St. Clair Hospital began providing an advanced brain imaging technology that has transformed the way some stroke patients are diagnosed and treated. CT perfusion scanning (CTP) is a specialized CT scan of the brain that can assess blood flow of brain tissue in people suspected of suffering an ischemic stroke, the type that occurs when a clot obstructs a large blood vessel in the brain. CTP enables St. Clair’s stroke team to identify which areas of the brain are damaged and which are at risk of further damage in specific stroke types. CTP helps guide diagnosis and treatment of ischemic stroke and can improve stroke care.

CTP is especially useful in the evaluation and management of “wake-up strokes,” says Maria Abraham, MPAS, PA-C, Director, Neuroscience Service Line at St. Clair. “A wake-up stroke means that a person goes to bed in their normal condition but wakes up in the morning with stroke symptoms. There’s no way to know the time of onset of those symptoms. Prior to 2018, the standard of care has been to offer clot removal only when it was known to have occurred within the previous six hours. As a result, persons with wake-up stroke symptoms had limited options. Only those who presented within six hours of last being well were considered for endovascular clot removal, if indicated.”

A transformative change in stroke care happened with the 2018 release of two major, multicenter studies: the DAWN study and the DEFUSE-3 study. The research demonstrated that in the appropriate patients, the treatment window for clot removal could be expanded from six to 24 hours after the patient was last known to be well. In doing so, they were able to show a significant decrease in disability. 

Stroke is the fifth leading cause of death in America and is the leading cause of permanent, life-altering disability. About 795,000 strokes occur in the U.S. every year, according to the National Stroke Association, with 75 percent affecting people older than 65. Nearly 90 percent of strokes are ischemic strokes. Traditionally, clinical decisions about stroke treatment have been largely time-based. “Time is brain” has served as an imperative: the earlier that treatment is initiated, the greater the chance to limit or reverse brain damage and achieve a favorable outcome. This remains true but now, with the availability of CTP imaging, the condition of brain tissue also determines treatment. 

“Anyone with stroke symptoms should go immediately to an emergency room,” says Abraham. “With the use of advanced imaging, St. Clair’s ER team will perform a comprehensive assessment, and determine the best treatment options for our patients.”