What Should You Do If You Suspect a Stroke?
Call 911 immediately — every minute counts. Use the BE-FAST acronym: Balance loss, Eyes (vision change), Face drooping, Arm weakness, Speech difficulty, Time to call 911. Note the exact time symptoms started. Do not drive to the hospital. Stroke treatments are most effective within 3 to 4.5 hours of symptom onset.
Time is brain — during an ischemic stroke, approximately 1.9 million neurons die every minute of untreated large vessel occlusion. Intravenous alteplase (tPA) can dissolve the clot and restore blood flow if administered within 4.5 hours of symptom onset, but earlier treatment dramatically improves outcomes. For every 15-minute reduction in treatment time, one month of disability-free life is gained. This is why calling 911 rather than driving is critical — EMS can pre-notify the hospital to activate the stroke team.
For large vessel occlusion strokes, endovascular thrombectomy — mechanical removal of the clot via catheter — has revolutionized acute stroke treatment. The landmark MR CLEAN, EXTEND-IA, ESCAPE, SWIFT PRIME, and REVASCAT trials all demonstrated dramatic benefit, with Number Needed to Treat (NNT) values as low as 2.6. Thrombectomy can be performed up to 24 hours after symptom onset in selected patients with favorable imaging, based on the DAWN and DEFUSE 3 trials.
Approximately 1.9 million neurons die every minute of untreated large vessel occlusion
What Causes Different Types of Stroke?
Ischemic strokes (87%) are caused by blood clots blocking cerebral arteries through three main mechanisms: large artery atherosclerosis, cardioembolism (often from atrial fibrillation), and small vessel disease (lacunar strokes). Hemorrhagic strokes (13%) result from ruptured blood vessels due to hypertension, aneurysms, arteriovenous malformations, or amyloid angiopathy.
Large artery atherosclerotic stroke results from plaque buildup in the carotid arteries or major intracranial arteries. Plaque rupture leads to local thrombosis or artery-to-artery embolism. Carotid stenosis greater than 70% is associated with significantly increased stroke risk and may warrant surgical intervention (carotid endarterectomy) or stenting. Cardioembolic stroke accounts for 20-30% of ischemic strokes, with atrial fibrillation being the most common source — AFib-related strokes tend to be larger and more disabling than other subtypes.
Small vessel (lacunar) strokes result from occlusion of small penetrating arteries deep in the brain, often related to chronic hypertension and diabetes. They typically cause specific clinical syndromes including pure motor hemiparesis, pure sensory stroke, and ataxic hemiparesis. Hemorrhagic strokes include intracerebral hemorrhage (ICH) — most commonly caused by hypertensive arteriopathy — and subarachnoid hemorrhage (SAH) — usually caused by ruptured cerebral aneurysms. Aggressive blood pressure management reduces hemorrhagic stroke risk by up to 50%.
Aggressive blood pressure management reduces hemorrhagic stroke risk by up to 50%
How Can You Reduce Your Stroke Risk?
Control blood pressure (the most important factor, responsible for 50% of strokes), treat atrial fibrillation with anticoagulation, quit smoking, manage diabetes, lower cholesterol with statins, exercise regularly, eat a Mediterranean diet, limit alcohol to moderate intake, and maintain a healthy weight. These measures can prevent up to 80% of strokes.
Hypertension management is the cornerstone of stroke prevention. The Global Burden of Disease study identified hypertension as the single most important stroke risk factor worldwide, contributing to approximately 50% of all strokes. Each 10 mmHg reduction in systolic blood pressure reduces stroke risk by approximately 33%. The SPRINT trial showed that intensive blood pressure control (target <120 mmHg systolic) reduced stroke risk by 43% compared to standard control (<140 mmHg) in high-risk patients.
For patients with atrial fibrillation, anticoagulation is the most effective stroke prevention strategy, reducing stroke risk by 60-70% with DOACs (apixaban, rivaroxaban, dabigatran, edoxaban). Smoking cessation reduces stroke risk significantly — the excess risk drops by 50% within one year and approaches that of never-smokers within 5 years. Statin therapy reduces ischemic stroke risk by approximately 15-25% independently of LDL levels. The SPARCL trial demonstrated that high-dose atorvastatin reduced recurrent stroke by 16% in patients with recent stroke or TIA.
The Global Burden of Disease study identified hypertension contributing to approximately 50% of all strokes
The SPARCL trial demonstrated high-dose atorvastatin reduced recurrent stroke by 16%
