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as for tPA – an absolute maximum of
six hours. And that’s usually true. But
recent research, including a study
published in January 2018, conduct-
ed by Professor Nogueira and others,
shows that in 30 per cent of major
stroke victims, enough blood can
bypass the blockage through smaller
blood vessels nearby to slow down
the destruction. And that can expand
the window for treatment. Doctors
determine who is benefitting from
such ‘collateral circulation’ by using
specialised brain scans. Surgeons can
sometimes perform a thrombectomy
up to 24 hours after a stroke’s onset.
Professor Nogueira cautions, how-
ever, that “[Collateral circulation]
is buying you time. But the brain is
still dying.” Someone who still has a
chance of recovery at six hours after
a stroke’s onset might no longer have
that chance at eight hours.
Jan woke after his thrombectomy
profoundly relieved to discover he was
already able to move his right arm and
leg a little. Within hours, however, his
leg and arm would not move again.
They were completely paralysed.
He had suffered a second stroke.
A person who has one stroke – espe-
cially if initial risk factors remain the
same – is at increased risk for another.
That risk remains high even ten years
after the first stroke. After performing
a second thrombectomy, stabilising
Jan and placing him in a coma for 48
hours to help him heal, doctors foundJan Heussen suffered a second stroke in hospital, not an uncommon occurrencePHOTO: HEINZ HEISS