APPLETON, Wis. (WBAY) – New guidelines from the American Stroke Association aim to save more lives as strokes have risen to the fourth leading cause of death in the U.S.
With help from CT technology, doctors can now identify blood clots earlier. Previously, the standard time to administer clot-busting medication was four and a half hours, but new recommendations can extend beyond that time.
“The new guidelines indicate we can rely on our CT scans and CT angiograms to help identify those patients who may still have the clot-busting medication, even beyond the 4.5-hour time window,” said Dr. Robert Jones, a neurologist with Ascension Medical Group, Fox Valley.
Extended treatment window
The American Stroke Association released the new guidelines in January. The clot-busting medication has been available for about 20 years, but the treatment window has expanded over time. The initial limit was three hours, which was later extended to 4.5 hours.
“Often, we were in situations where we really didn’t know when symptoms started. Often, people would say, wake up with a stroke,” Jones said.
CT angiograms focus on perfusion, measuring how fast contrast can get into brain tissue.
“If it takes more than six seconds, there’s something impeding the flow,” Jones said. “If the blood flow is less than 30%, there’s usually an infarct, and we can’t save that. But if we have the prolonged time and the preserved cerebral blood flow, that’s a penumbra. If we see the penumbra, we can save that brain if we act fast enough.”
Recognizing stroke symptoms
Jones said officials recommend the public use the acronym BEFAST to identify stroke symptoms: balance problems, eye issues such as double or blurry vision, facial weakness, arm weakness, slurred speech and time to call an ambulance.
“We are also concerned about numbness. We’re also concerned about severe headache, the worst headache of your life,” Jones said.
The slogan “time is brain” reflects the urgency of stroke treatment.
“We’re trying to save as much brain as possible that may not get in blood flow,” Jones said.
Emergency rooms aim to complete the process of getting a patient through a CT scan and making treatment decisions within half an hour in some cases.
Additional treatment options
Beyond clot-busting medication, interventional radiologists can use clot-retrieval devices up to 24 hours after stroke onset.
“They can go up with the catheter, they can open up the stent retrieval device, and they can simply pull back the plug and restore blood flow,” Jones said.
Jones said patients should work with their primary care doctors on stroke prevention, especially monitoring blood pressure, blood sugar and cholesterol. After a stroke, guidelines for lowering blood pressure and cholesterol become more stringent.
Smoking remains one of the major factors in stroke and heart disease, Jones said.
Copyright 2026 WBAY. All rights reserved.
