Brain Awareness Week: Surviving a stroke shouldn’t be about luck

Without blood flow, the brain dies faster than any other organ in the human body. During an ischemic stroke, a clot stops blood from reaching the brain, causing about 2 million brain cells to die each minute. The resulting brain damage can be debilitating, including the loss of speech, mobility, vision — and even death.

When it comes to stroke treatment, time is of the essence for a good outcome. Three out of four patients who experience a large vessel occlusion stroke are dead or disabled in 90 days. A procedure called neuroendovascular surgery has been proven highly effective at treating severe ischemic strokes.

{mosads}But because of outdated state policies, less than 10 percent of the roughly 120,000 severe stroke patients receive this treatment. Most patients are, by default, triaged to the nearest hospital and wait — sometimes for hours — for the proper assessment and care.

Much like the designation of Level 1 Trauma Centers — which are capable of providing specialized, complex care for serious trauma — similar clear designations are needed for stroke.

Well-intentioned legislation is emerging in several states to increase the number of stroke centers, but the criteria are still unclear. This labeling confusion means that a severe stroke patient may not get to a facility that provides this procedure in time, unnecessarily jeopardizing their chances for the best possible outcomes.

As such, a Level 1 Stroke Center should be defined by the ability to consistently and efficiently deliver neuroendovascular surgery with continuous availability, 24 hours a day, 7 days a week, 365 days a year.

A few things set specialized neuroendovascular-ready facilities apart. First, they are staffed to provide stroke surgery for severe stroke patients year-round, every day, every hour. Second, these care teams are specially trained in treating one organ: the brain. And third, they perform neuroendovascular surgery on a regular basis.

A recent study showed that severe stroke patients who do not go directly to a neuroendovascular-ready facility, but are transferred to one later, experience delays of getting neuroendovascular surgery by about 90 minutes. We know this is critical time lost, because for the best possible outcome, a severe stroke patient needs to receive stroke surgery as early as possible, with the potential benefit oftentimes disappearing after six hours. Yet, one out of every three stroke patients who experience this hospital transfer confusion become ineligible for neuroendovascular surgery by the time they reach a team that could help them. With hours lost, so are brain cells, and severe damage is usually irreversible.

Right now, several states are considering legislation or rule changes that would expedite treatment of stroke patients — a change that will save lives and reduce long-term health care costs. A win-win. A campaign by the Society of NeuroInterventional Surgery called Get Ahead of Stroke aims to improve the system of stroke care through policy change in all 50 states.

In several states, neurointerventionalists and other health care providers who have a deep understanding of the challenges inherent to stroke treatment are working with local task forces to update stroke protocols so that all severe stroke patients have an equal chance at survival – not just the lucky ones.

Stroke is a leading cause of disability in the United States, taking a financial toll on Medicaid, Medicare, private payers, and families. As state policymakers work to improve stroke systems of care, SNIS and the Get Ahead of Stroke campaign encourage them to consider measures that educate first responders to recognize patients with severe strokes, and facilitate transport of these patients directly to a neuroendovascular-ready facility.

As we observe Brain Awareness Week from March 13 to March 19, it’s time to tell state and local policymakers that saving lives and money and reducing disability should be a no-brainer.

Marie Williams, CAE, is the executive director of the Society of NeuroInterventional Surgery, a scientific and educational association dedicated to excellence in comprehensive, minimally invasive care of patients with stroke, brain aneurysms, and other diseases in the head, neck, and spine.

The views expressed by contributors are their own and are not the views of The Hill.