If a clot ever blocks an artery to your brain, or if you start bleeding into your skull, the next few hours of your life are critical, and they could be your last.

From a stroke’s onset, doctors have a three to four-and-a-half hour window to intravenously inject a clot-busting drug called tissue plasminogen activator, said University of Iowa neurology Professor Harold Adams, the director of the UI Hospials and Clinics Stroke Center.

“The clock moves very fast in that situation,” he said.

The leading cause of long-term disability in adults, strokes result in roughly 1,600 deaths each year in Iowa,

According to the Centers for Disease Control and Prevention, each year more than 795,000 people in the United States have strokes, killing almost 130,000.

On May 13, the UI center joined an elite cadre of 35 other such institutions in the nation when it was awarded the highest stroke accreditation offered by the Joint Commission, the Advanced Comprehensive Stroke Center Certification.

The commission is an independent accreditation agency for health-care organizations that created the new standard roughly a year ago in collaboration with the American Heart Association/American Stroke Association, said Jean Range, the executive director for certification programs at the Joint Commission.

The UIHC Stroke Center admits 900 to 1,000 patients annually and sees around three new patients every day, Adams said.

Commission officials visited the UIHC in January, Adams said, and they will return in about two years when the time comes for recertification.

Joint Commission official Bret Coons estimated that only around 500 institutions nationwide even have the resources to be even able to apply for such a s status. 

Research universities with the requisite resources are busy working toward the certification, and many of them currently hold the decade-old Advanced Primary Stroke Center Certification.

As of Wednesday, 48 advanced comprehensive stroke centers have been named.

“This outstanding achievement is the result of many years of hard work, training, teamwork, and dedication to our patients,” said UI Vice President for Medical Affairs Jean Robillard in a press release.

Adams said strokes can affect all ages but are more likely to occur in older individuals.

“The primary — the first level — was so successful in driving hospitals to follow best practice standards and improved care,” said, Kathy Morrison, stroke program manager at Penn State Hershey Stroke Center, who sat on the technical advisory panel that helped write the new standards.

But she said the primary certification standard didn’t provide enough oversight for newer, more advanced stroke treatments, nor did it require hospitals be able to handle numerous stroke victims at any time of any day.

Penn State’s Primary Stroke Center had its on-site review in May and hopes to receive Comprehensive Stroke Center Certification soon, she said.

Comprehensive centers must offer treatments such as endovascular therapy, Adams said, which is used in patients that can’t receive tissue plasminogen activator. In those cases, a very small tube is inserted into the bloodstream and guided through the arteries to the brain.

The University of Arizona’s Primary Stroke Center added endovascular capabilities July 1, and while officials there look forward to pursuing comprehensive certification, the center does not yet meet the requirements, said Leslie Ritter, the stroke coordinator.

“The excellence comes first, and then the certification follows,” she said.

Smokers and people with diabetes, heart disease, high blood pressure, or high cholesterol are high-risk, Adams said. “The best treatment of stroke is to prevent it from happening to begin with, which includes things to treat high-risk people, such as medications [or] lifestyle changes.”