'The Golden Hour', stronger: Significance of timely stroke treatment for improved outcomes

KUALA LUMPUR: Stroke is the third most common cause of death in Malaysia in 2023 and is predicted to climb to the second by 2040, according to the Department of Statistics Malaysia (DOSM). One in four Malaysians could suffer a stroke in the same year if no preventive action is taken.

The Health Ministry (MOH) supported the prediction by DOSM, highlighting stroke as a major cause of mortality in its Clinical Practice Guidelines 2020, with ischaemic stroke being the most prevalent form. This alarming trend underscores the urgent need for effective prevention and treatment strategies.

Sunway Medical Centre Velocity (SMCV) consultant neurologist and internal medicine physician Dr Kok Chin Yong said ischaemic stroke occurs when the blood supply to parts of the brain is obstructed, preventing brain tissue from receiving oxygen and nutrients, leading to cell death within minutes.

"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," he said in a statement to Bernama.

Ischaemic stroke could result in various neurological implications including muscle paralysis such as facial weakness and numbness, as well as speech difficulties, visual disturbances, gait imbalances, dizziness and long-term muscle stiffness that may impair daily activities.

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'.

'The Golden Hour' 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," explained Dr Kok. Mechanical thrombectomy would be performed for stroke patients with larger blood clots by using a device to physically re move 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 six hours of stroke onset but can still be beneficial if performed within 24 hours in certain cases," the statement read. SMCV consultant radiologist and neurointerventional radiologist Dr Rozman Zakaria elaborated 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 highlighted 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," he added.

Thus, he said 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 per cent 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 per cent of stroke patients and reduces post-stroke symptoms in over 40 per cent of patients," he said. Dr Kok also emphasised 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.

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 Razman both also emphasised the importance of continuing rehabilitation in stroke treatment, which can significantly improve the quality of life and independence, reducing the need for assistance in daily activities as well as further improving the physical and cognitive abilities of the patient.

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

Dr Kok said being physically active, eating Omega-3-rich foods, and consuming fish five or more times a week can lower stroke risk by 60 per cent while managing hypertension and diabetes is crucial as they promote plaque buildup in blood vessels, potentially causing blockages in blood flow to the brain, leading to sudden stroke symptoms.

He also observed an increase in stroke among younger people often linked to a 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 could significantly improve patient outcomes and reduce long-term disabilities. Patients must seek immediate medical attention if they are experiencing stroke symptoms and 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," the statement concluded.

-- BERNAMA

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