1. Stroke 101

2. Subject Expert
Michelle Whaley MSN, CNS, CCNS, ANVP-BC Swedish Medical Center Englewood, CO

3. Objectives Types of strokes Stroke warning signs Stroke risk factors
Medical test performed following a stroke
Emergency treatments available for stroke patients
Primary and secondary stroke prevention

4. What Is a Stroke?
A stroke is caused by the interruption of normal blood flow to arteries in the brain
Some strokes are small, others are large
Strokes can be ischemic or hemorrhagic

5. Stroke Types 87% of strokes are ischemic
They are most often caused by a blockage or a blood clot
13% of strokes are hemorrhagic
They are most often caused by the rupture of a blood vessel
American Heart Association, 2017
MRI image with multiple small, ischemic strokes Courtesy of Swedish Medical Center

6. Ischemic Stroke
Hemorrhagic Stroke 6

7. Stroke Types Ischemic (blood clot) stroke Embolic
- Blood clot forms and travels to the brain
- Often originates in the heart
Thrombotic
- Cholesterol plaque breaks off and causes blockage
- Artery becomes blocked at the plaque 7

8. How Common Is Stroke? Stroke is the 5th leading cause of death
Nearly 800,00 strokes occur each year
1 every 40 seconds
Over 140,000 deaths from stroke each year
1 out of every 20 adult deaths in the U.S.
Stroke is a leading cause of serious, long-term adult disability in the U.S.
Prevention is the best treatment!
Data from, CDC and American Heart Association, 2017

9. Stroke Warning Signs Sudden onset, with no known cause Weakness
Numbness
Difficulty speaking or understanding words
Vision loss
Trouble walking, dizziness
Severe headache

10. Why Did I Have a Stroke? 10

11. Stroke Risk Factors Modifiable Non-modifiable High blood pressure
Heart disease
Atrial fibrillation
Smoking
High cholesterol
Diabetes
Carotid artery disease
Heavy alcohol use
Drug abuse
Age
Gender
Race
History of TIAs or prior stroke
Family history 11

12. Disease “Tiny arteries become narrow or get blocked by cholesterol
Why Did I Have a Stroke?
Other causes
Cryptogenic “Unknown”
Small vessel
Disease “Tiny arteries become narrow or get blocked by cholesterol 12

13. Medical Tests Following Stroke
MRI of the brain
- Determines location and size of stroke
Ultrasound of the carotid arteries
- Looks for areas of narrowing or plaque
Ultrasound of the heart
- Examines the function of the heart
Heart monitor
- Watches for abnormal heart beats
Blood tests
- Determines cholesterol and blood sugar levels

14. What emergency treatments are available?14

15. Acute Ischemic Stroke Treatment
Clot busting medications
IV Alteplase (tPA)
Can be given up to 4.5 hours from the time a person was last seen normal
Not every person is a candidate for this treatment
Only people who get to the hospital right away are eligible for this treatment. Don’t delay! 15

16. Acute Ischemic Stroke Treatment
Surgical treatments
Clot removal from the artery using catheter
Can only be used in the larger arteries of the brain
Time is important. Don’t delay!

17. Acute Hemorrhagic Stroke Treatment
Treatments depend on type of hemorrhage
High blood pressure (most common cause)
Lower blood pressure with medication
Aneurysm (least common cause)
Surgical treatment to prevent aneurysm from re-bleeding

18. Stroke Prevention is the Best Treatment!
Primary
Prevent a first-ever stroke
Secondary
Prevent another stroke from happening again

19. Primary Prevention If you smoke, STOP! Control blood pressure
Keep LDL cholesterol < 70 mg/dL
Control blood sugar
Atrial fibrillation (irregular heartbeat)
Discuss the use of blood thinners with your doctor or nurse
Eat a healthy diet
Increase physical activity

20. Primary Prevention Smoking New treatments are available
Talk to your doctor
Multiple attempts might be necessary
Don’t get discouraged if you fail, keep trying

21. Primary Prevention Hypertension Goal BP < 130/90 mm Hg
Small changes result in a greater decrease in stroke risk
Lower is better!
Diabetes
Normal finger stick blood sugars
mg/dL
Hemoglobin A1c blood test
< 7.0%
Cholesterol
LDL (bad cholesterol) < 70 mg/dL
Control with healthy eating, physical activity, and/or medication

22. Atrial Fibrillation (AFib)
Irregular heart rhythm
Predisposes to stroke
During heart pauses  blood pools  forms a blood clot  travels to the brain  STROKE
Stroke prevention
Blood thinning with anticoagulants
Warfarin (Coumadin)
Keep INR blood levels between 2 - 3
New Medication (Pradaxa®, Xarelto®, Eliquis®)
More expensive than Warfarin, but no blood testing needed

23. Carotid Artery Disease
Narrowing of the carotid artery
>70% blockage meets criteria for surgery
Carotid stent or open surgery
Even if no history of stroke

24. Primary Prevention Sickle Cell Disease (SCD)
Predisposes patients to stroke (mostly children of African-American descent)
Transcranial Doppler (TCD) Ultrasound helps select patients who need blood transfusions
Transfusions significantly reduce the chance of having a first-time stroke by 91%

25. Secondary Prevention Antiplatelet medications Aspirin Clopidogrel
Extended-release dipyridamole/aspirin
Blood thinners
Warfarin
Pradaxa®, Xarelto®, Eliquis®
More aggressive lowering of cholesterol
Surgery to remove carotid plaque or use of stent

26. Secondary Prevention
High Blood Pressure (Hypertension)  Small reductions = BIG impact on stroke

27. Stroke Risk Reduction

28. High Blood Pressure You may need more than 1 medication
Goal < 130/90 mm Hg
Get your own blood pressure cuff
Take your blood pressure twice a day
Record your reading and share with your doctor or nurse

29. Diabetes Goal is to get sugars back to a normal range
Hemoglobin A1c test
Average of blood sugars over 3 months
Goal for stroke patients <7.0%
May need multiple medications including insulin

30. High Cholesterol Two important types of cholesterol
LDL (“bad”) HDL (“good”)
Statin medications: goal is primarily to get the LDL lower
Statins: depends on whether there is a history of heart disease
If history of heart disease and stroke
Start if the LDL is >100 mg/dL
American Stroke Association, 2014

31. Healthier Eating Modify and improve what you eat
Monitor portion control
Increase fruits, vegetables and whole grains
Bake, roast or grill foods
Drink water

32. Be Active It all adds up – do what you can do!
Improvement comes from you! Patient has to be motivated to move or do exercises.
Do it safely
Work up to 30 minutes/day for exercise
Can include walking, chair exercises, riding a bike, and gardening

33. A Dreaded Second Stroke
Within 5 years of your first stroke
Your risk for another stroke can increase more than 40%
24% of women and 42% of men will experience a second (recurrent) stroke
Recurrent strokes
Higher rate of death and disability because parts of the brain already injured by the original stroke may not be as resilient

34. “But Doc….I Feel Fine” Goal is prevention
You won’t feel the medications working
Follow your doctor’s instructions and take your medication

35. Questions? 35

36. Learn more at stroke.org
THANK YOU!
Learn more at stroke.org
1-800-STROKES
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©2017 National Stroke Association