Luke Perry died Monday (March 4), less than a week after the actor reportedly suffered a stroke. But while Perry’s death comes as a surprise—at 52, he was relatively young and appeared in good health—it’s a sobering reminder of the deadly impact of the disease.
Stroke is a massive killer. It is the second leading cause of death globally, behind only its close cousin, heart disease. About 15 million people suffer strokes each year, and it kills almost 6 million of them.
Source: World Health Organization
In the US, advances in prevention and emergency care have reduced the number of strokes and the rate of fatality in recent decades, but it is still the fourth-most deadly disease in the US, claiming 142,000 lives a year.
Stroke is particularly difficult to treat because it behaves less like a disease, and more like a car crash. It occurs suddenly, often without warning, and demands an immediate response.
When a stroke deprives brain cells of blood, they die in droves. The longer treatment is withheld, the more brain cells are killed, and time is of the essence. A stroke can test the capabilities of a health-care infrastructure, and delivering care requires the sophisticated coordination of ambulances, emergency rooms, and neurologists. For victims who live in rural areas or in poor countries without developed emergency medicine systems, care may arrive too late.
The one approved drug, alteplase, dissolves the obstructions in blood vessels that cause the majority of strokes. But some strokes aren’t caused by obstructions, but by uncontrolled bleeding in the brain, and alteplase can be fatal in those patients. So stroke victims must first be examined with a CT scan or MRI, adding further delay to the process—alteplase is recommended only in the first three hours after a stroke—and essentially ruling out the drug in much of the developing world, where stroke is reaching epidemic levels.
After years of frustration with their lack of options, neurologists are now celebrating the advent of a new technology that allows them to insert catheters into blood vessels and remove the obstructions. While stroke patients who receive this mechanical thrombectomy fare dramatically better than those who receive alteplase, it is an expensive and sophisticated surgery available to a tiny percentage of patients.
Researchers and drug companies have spent decades, and billions of dollars, searching for a drug that can slow brain death after strokes without success, and that can be given safely before a patient is scanned. It remains the “holy grail” of stroke treatment, in the words of UCLA’s Jeffrey Saver, a leading stroke researcher.
In the meantime, the best hope for most of the world’s potential stroke patients is not having one in the first place. After spending much of its energy on slowing the spread of communicable disease like HIV, malaria, and Ebola, the world health community is turning its attention to preventing noncommunicable illnesses in the developing world. The good news is that many solutions are readily available, such as banning trans fats and making low-cost hypertension drugs widely available. The bad news is the problem is enormous and resists quick fixes. Changing a nation’s diet can take decades.
It’s not clear what sort of stroke Perry suffered, or how he was treated. But he was an affluent American living a major city, presumably with access to the world’s best care. If he can’t survive a stroke, it speaks to the obstacles facing the millions of stroke patients in less privileged circumstances.