New Orleans ? Ten years ago, a crucial study proved that a drug could limit the damage from one of nature’s biggest disasters: a blood clot stuck inside the head.

The drug, TPA, was so powerful at dissolving blockages threatening to destroy parts of the brain that the first patient to get it, a 67-year-old man, regained the ability to walk and talk half an hour after it started flowing through his veins.

“The nurses at the bedside started crying. It was very dramatic,” recalled Dr. William Barsan, who treated him.

TPA remains the sole drug approved for strokes. Yet only about 3 percent of victims get it.

Usually that’s because they don’t seek help until it’s too late for the drug to do any good — three hours after symptoms start.

However, fresh research documents disturbing problems that keep this lifesaving treatment from reaching the roughly one in five stroke victims who do seek help in time. Studies presented at an American Stroke Assn. conference last week found that:

• Operators answering phones at hospitals often don’t recognize stroke symptoms and discourage callers from coming in for help.
• Ambulances routinely take people to the nearest hospital instead of one with the necessary equipment and expertise to give TPA.

Unlike heart attacks, strokes usually cause no pain, so the warning signs often are missed by victims and people around them. According to the American Stroke Assn., symptoms include:¢ Sudden weakness or numbness of the face, arm, leg or one side of the body.¢ Sudden dimness or loss of vision, especially in one eye.¢ Difficulty or inability to speak.¢ Sudden severe headaches.¢ Unexplained dizziness or sudden falls.

• Emergency room doctors are afraid of the drug’s potentially serious side effects, and are unwilling to use it even when test results clearly show they should.
• Even specialized stroke centers designed to speed the drug to patients are missing many chances to get it right.

“It’s like we’ve built a cascade of system failures here. Every place along the stream is another place something can go wrong,” said Dr. Larry Goldstein, director of Duke University Medical Center’s stroke program and member of a task force aimed at improving the situation.

The courts may provide added incentive to do so: Hospitals increasingly fear lawsuits if they fail to give the drug in time.

The consequences of missed opportunities are huge. Stroke is the third leading cause of death in the United States, behind heart disease and cancer. It’s a chief reason for disability and forces many people to spend their final days in nursing homes, unable to walk, talk or see as they once could.

About 700,000 strokes occur each year, and nine out of 10 are due to a clot. Little could be done for them until doctors tried TPA, a medication used to dissolve clots causing heart attacks, for stroke.

The 1995 study, funded by the federal government, proved that it worked. Stroke victims treated with TPA were twice as likely to have a good outcome as those who were not. The Food and Drug Administration approved it for stroke the next year, and a move grew to treat strokes as “brain attacks,” emergencies requiring swift treatment to prevent permanent damage.

Dr. Lee Schwamm, associate director of Massachusetts General Hospital’s stroke program, called it a landmark event. “It signaled the end of therapeutic nihilism, the idea that if you were having a stroke it was just too bad, that you ought to go in a dark room and come out when it’s over.”

However, there is a dark side to this miracle-working medication. About 6 percent of stroke patients who get it develop bleeding in the brain, which is fatal half the time. This can be avoided by not giving it to those with bleeding ulcers, very high blood pressure or certain other conditions.

But many emergency room doctors have been afraid to give TPA without neurologists to back up their judgment, and most hospitals don’t have neurologists in the ER.

There are problems before patients arrive, too. Dr. Brent Jarrell of Cabell Huntington Hospital in West Virginia studied how hospital operators and helplines in several states responded to hypothetical calls describing classic stroke symptoms.

“Roughly 25 percent of the people were referred back to their primary care doctor,” he said. “The kind of the feeling, when you talk to them, is that they were trying to keep people away from the hospital.”

One in five operators couldn’t identify a single stroke warning sign.

Many efforts are under way to improve things. Last year, the Joint Commission for Accreditation of Healthcare Organizations started accrediting stroke centers meeting strict standards, such as seeing every patient within five minutes of arrival. So far, 88 hospitals in 28 states have earned the title and hundreds more are seeking it.