If you or a loved one is at risk for stroke, you're probably familiar with FAST, the acronym that signals a stroke and tells you how to respond to it: Facial weakness or numbness, Arm weakness or numbness, Slurred speech, and Time (getting to the hospital quickly).

Now there's another piece of information to remember: Several new studies have found that treating a stroke with a combination of the clot-busting drug called tissue plasminogen activator (tPA) and a stent, a small device that snares and removes any remaining clots in the blood vessel to the brain, is more beneficial than either treatment alone.

Best for Ischemic Strokes

Four studies published over the past several months have shown that the combination therapy improves function and decreases mortality in people who have had ischemic strokes, which occur when vessels supplying blood to the brain are blocked. For patients with hemorrhagic strokes, which occur when a blood vessel ruptures and bleeds into the brain, this combination is dangerous, so it's essential to get a computed tomography (CT) scan to determine what kind of stroke the person has before starting treatment.

In the first study, known as MR CLEAN, published online in the New England Journal of Medicine in December 2014, Dutch investigators reported that patients treated with clot removal by stent in combination with tPA functioned better 90 days after the stroke than patients who received tPA alone. Three more trials presented at the American Heart Association/American Stroke Association International Stroke Conference in February had similar results. In fact, two of the studies, known as ESCAPE and EXTEND-IA, were stopped early because of the clear benefit of the combination treatment.

Faster Recovery

In the ESCAPE trial, conducted in Canada, patients not only functioned better with the combination treatment, but the mortality rate from stroke was also significantly reduced. Two of every 10 patients receiving standard treatment died, compared with one in 10 deaths among those who had the combination treatment.

"This is very exciting," says Mitchell S. Elkind, MD, a neurologist and stroke specialist at Columbia University Medical Center in New York and a Fellow of the American Academy of Neurology. "These studies show that immediate medical intervention with this combination therapy leads to a pretty dramatic benefit in terms of people's outcomes and function."

Improved Devices

Results from earlier studies that tested this combination were less positive, but stroke experts say that's probably because there have been major improvements in the way clot-retrieval devices are designed and how quickly they are used post-stroke. "The newer devices are a lot more effective at removing blood clots," says Dr. Elkind. "These studies are proving that with newer devices, this combination therapy can really make a difference. I think we're going to see a real revolution in our treatment of stroke."

What Does This Mean for Me?

The biggest take-home message about stroke is this: Recognize the symptoms and get to the hospital as quickly as possible.

We asked Mitchell S. Elkind, MD, a neurologist and stroke specialist at the Columbia University Medical Center and a Fellow of the American Academy of Neurology, to answer some other important stroke questions:

How soon should treatment start? "The standard time for starting intravenous (IV) tissue plasminogen activator (tPA) after the onset of symptoms was three hours, but a recent study suggested it could be extended up to four and a half hours. The MR CLEAN study used a time of six hours, while the ESCAPE study used a 12-hour window."

What does the stent procedure involve, and are there any complications? "Doctors insert a mesh catheter with a grasping device through a small incision in the groin and thread it up through the body to the blood vessel in the brain to retrieve the clot. One possible complication is bleeding in the brain. It happens in 2 to 3 percent of cases and can be fatal. After the procedure, doctors use computed tomography (CT) scanning to watch closely for early signs of bleeding so they can intervene quickly."

Where should I go (or take someone) in the event of a stroke? "Ideally you want to go to a primary stroke center, which would have an acute stroke team, brain imaging capabilities, and neurosurgical services. But don't look for one on your own. Call 911; the emergency medical personnel are trained to take you to the nearest center."

How many stroke centers offer the combination treatment? "Some primary stroke centers may offer it, but more highly specialized comprehensive stroke centers have the most experience with it. Check with your local hospital to see if their staff neurologists are familiar with the procedure."

What if I don't live near a center that provides the combination treatment? "Call 911 and get to the nearest emergency room immediately. Once there, hospital personnel will do a CT scan and decide whether to administer tPA intravenously. If necessary, they will call or videoconference with experts at a comprehensive stroke center. After the IV tPA is started, if appropriate, the patient will be transferred to a comprehensive stroke center. This tactic, known as 'drip and ship,' is the best strategy for patients whose nearest hospital isn't able to administer the combination treatment."