Docs push for better awareness on strokes

Nancy Forem missed the narrow time window when clot-busting drug therapy could effectively break up the blockage in her brain that was causing a stroke.

The Northport single mom suffered the severe attack last year shortly after putting her 6-year-old daughter to bed.

Forem, found by a friend, went untreated for nearly five hours. She was rescued through a daring procedure that involved destroying the clot by way of a catheter threaded through a vessel in her leg.

Many people, though, aren't as fortunate.

Of the 32,000 strokes that occur each year in New York, roughly 6,000 affect people on Long Island, according to state Health Department data.

Doctors are voicing concern: Too many people are missing the window for the gold standard of care, either because those around them don't recognize stroke symptoms or the person is alone at the time of the stroke. They're calling for stronger public education campaigns and spreading the word about stroke prevention.

Only 3 percent to 8.5 percent of patients are reaching emergency rooms in time for the federally approved therapy, according to the Centers for Disease Control and Prevention.

Under Food and Drug Administration guidelines, that treatment -- the clot-dissolving drug TPA (tissue plasminogen activator) -- must be administered within three hours of an ischemic stroke, which is the most common and is caused by a blood clot.

Another treatment -- the mechanical thrombectomy that rescued Forem -- must be performed within eight hours.

A stroke is essentially a brain attack, but unlike its counterpart that affects the heart, surveys show the public generally doesn't recognize stroke symptoms. And some people with minor strokes, known as transient ischemic attacks, may not seek treatment at all, said Dr. Jeffrey M. Katz, director of the Comprehensive Stroke Center at the North-Shore Long Island Jewish Health System.

These minor strokes can cause sudden numbness on one side of the body, confusion, or an inability to speak. Symptoms usually pass but can serve as a harbinger of a more damaging stroke.

An estimated 10 percent to 20 percent of strokes occur during sleep, which means by the time anyone is aware of a patient's disability, too many hours have passed for TPA to help, Katz said.

When Forem arrived last May at Huntington Hospital, it was too late for TPA -- and the clock was still ticking. She was paralyzed on the right side of her body.

"It was very serious," said Dr. John Pile-Spellman, neurointerventional radiologist at Neurological Surgery in Lake Success.

He and his colleague, Dr. Jonathan Brisman, an endovascular neurosurgeon, are summoned to aid stroke patients at several smaller hospitals on Long Island, including Winthrop-University Hospital in Mineola, South Nassau Communities Hospital in Long Beach, and Huntington.

Once or twice a month, they perform mechanical thrombectomies, conducting the procedure with micro-catheters. The device is inserted into an artery in the leg, which provides a pathway to the obstructed vessel in the brain.

"Every second counts in stroke treatment," Pile-Spellman said. "But when it is too late to give TPA, or when TPA doesn't work, mechanical thrombectomy can be highly effective."

Katz also performs the procedure at North Shore, as do physicians at Stony Brook University Medical Center, which has a comprehensive stroke treatment center.

"Mechanical thrombectomy represents a major advance in stroke treatment, because it can pick up where TPA leaves off," Brisman said. "This can mean saving precious brain tissue and minimizing long-term damage."

Katz cautioned that the invasive procedure is not for all patients who miss TPA's deadline. "The stroke has to involve a large vessel in the brain, and most strokes do not involve large vessels," he said.

Dr. Roger Bonomo, director of stroke care at Lenox Hill Hospital in Manhattan, praised the procedure but noted that it would be helpful for patients if the FDA would simply extend the three-hour time window for TPA. European studies suggest the drug can be effectively administered up to six hours after a stroke.

Forem, 42, says memories of her stroke are still vivid. She recalls falling to the floor and having no feeling in her right arm or leg. She had also lost the ability to speak.

She dragged herself to her cellphone to call her parents, a number she had called countless times. She couldn't remember it.

Finally, she remembered the number of a friend and punched it in with her left hand, but when she tried to talk, she couldn't.

The best she could manage was a series of sounds into the phone. Instinctively, her friend realized something was wrong and rushed to Forem's house.

Today, she has only subtle evidence of having suffered a stroke.

"I have a problem sometimes with word retrieval," said Forem, art director for a Plainview advertising company. "But I can still draw and use a mouse."

Corrections: Because of editing errors, a previous version of this story misspelled Pile-Spellman's name and gave an incorrect name of his practice. Brisman's name was also misspelled and his title was incorrect.