'Time is brain': Neurologist explains why Utah leads nation in stroke treatment time

MURRAY — Ann Itchon says she will never forget the sound of her husband falling in the bathroom the night he suffered a stroke.

On Jan. 23, 2024, Ted Itchon woke up around 2 a.m. to use the bathroom and lost his balance, causing him to collapse onto the floor. Ann found him quickly after and called 911. She says she had no idea what was wrong until she overheard a paramedic saying Ted might be having a stroke.

In the time it took Ann Itchon to leave their house and meet her husband at the hospital emergency room, first responders had already assessed Ted and provided him a stroke-stopping medication that prevented further damage to his brain.

Dr. Paul Johnson, medical director of the Comprehensive Stroke Program at Intermountain Medical Center, and the neurologist who treated Ted Itchon that night, explained that medical staff work as fast as possible when treating a stroke patient because, for every second they are experiencing a stroke, 32,000 neurons in the brain die.

"A stroke is a very time-sensitive disease. When somebody is having a stroke, it's just a matter of time until you have a permanent brain injury," said Johnson. "We often say, in the stroke world, that 'time is brain.' Every minute you delay care, it costs brain cells. The sooner somebody comes into the hospital, the sooner we can intervene and prevent that injury from happening."

Utah was recently ranked as the top state for providing the fastest stroke treatment in the nation by the American Heart Association, according to Intermountain Health.

The American Heart Association recommends that patients receive a tissue plasminogen activator medication to dissolve blood clots in the brain within 60 minutes of arriving at the hospital. In Utah, 87.1% of stroke patients received the medication within 45 minutes of their arrival, making it the only state in the country reaching that goal for over 85% of patients. Furthermore, Intermountain Health reports 94.5% of patients arriving at its stroke centers receive the medication within 45 minutes, and 88% receive it in 30 minutes or less.

To improve its door-to-needle time, Johnson says Intermountain Health has implemented changes such as having the blood clot-dissolving medication premixed, expediting CT scans, and improving the emergency department workflow overall. The health care system also has a stroke neurologist on staff 24/7 to ensure patients can be diagnosed and treated as quickly as possible.

"We have been able to treat patients very quickly because we — along with our sister hospitals in the state — have focused very intensely on assessing patients, when they come to the hospitals, as quickly as possible," said Johnson. "We have worked very closely with EMS crews, with the ER doctors, with our nurses in the ER, to make sure that we shave off every minute that we can ... so that when a patient like Ted comes in, we are very quickly able to get the data that we need."

When a patient arrives at the emergency room, medical staff must be able to determine definitively that the patient is having a stroke before administering the medication to stop it. They also need to verify the patient's medical history and what medications they may be taking to ensure nothing will interfere with the stroke treatment medication.

In Ted Ichton's case, doctors also had to perform a thrombectomy, or surgical procedure to remove blood clots from arteries in the brain, in addition to administering the tissue plasminogen activator medication. Because his specialized stroke team was able to move so quickly in treating him, Ted Itchon says most people he meets don't even know he suffered a stroke.

"I can't tell you how much I appreciate the doctors. They were fantastic, and I enjoyed them, even though I wanted to get out (of the hospital). I don't even know how to explain the gratitude I have," he said. "If it wasn't for Ann and her diligence, her quickness of calling 911, I would probably be less than what I am now."

Ted Itchon was able to return home just four days after his stroke. While he still required outpatient physical therapy sessions to help him recover some speech skills and treat his foot that was affected by the stroke, Johnson says Ted Itchon experienced a relatively speedy recovery thanks to the quick door-to-needle time he received.

Typically, a stroke occurs when a blood clot blocks an artery, preventing blood flow and oxygen delivery to the brain, which can result in the death of brain cells. Strokes are most common in older adults — especially those with high blood pressure, high cholesterol and diabetes — but can happen to anyone, according to Johnson. As strokes are the fifth-leading cause of death in the U.S., he encourages people to be informed so they can help themselves or loved ones suffering from a stroke.

"We always like to remind people that we use the mnemonic device BEFAST to remind patients and the public what to look out for for a stroke: sudden severe balance problems, eye problems — so vision loss on one side or the other — facial droop, arm weakness, speech problems .. and then 'T' is time, so time to call 911 and time to come in and seek treatment," said Johnson.

After calling 911, Johnson says one of the best things a loved one can do to expedite the door-to-needle time for someone suffering from a stroke is to know what medications they take and be prepared to provide their medical history. Most stroke patients are unable to speak clearly or coherently, so having a family member or friend's number to contact for information can help first responders and hospital staff.

Finally, prevention can be the best medicine for some stroke patients, according to Johnson. While not all strokes are preventable, 80% are if patients receive treatment for conditions that make them higher risk for stroke, like high blood pressure, cholesterol, diabetes and smoking.

For more information on stroke risk or recovery, visit the American Heart Association's stroke website.

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