What is the duration of a choke that can cause a stroke?

Duration of Choke Required to Cause a Stroke

There is no established safe duration for a choke hold, as even brief compression of carotid arteries can potentially cause a stroke, especially in individuals with pre-existing vascular risk factors.

Mechanism and Risk

Sportive choking or "chokes" in combat sports involve compression of the jugular veins and carotid arteries, which reduces cerebral perfusion pressure 1. While this is commonly practiced in combat sports and military/police training, it carries significant risks:

• Compression of cervical arteries can lead to:
  • Carotid artery dissection
  • Vertebral artery dissection
  • Ischemic stroke without dissection 1

Documented Cases

A case series documented 10 cases of cervical artery dissections and ischemic strokes associated with sportive chokes, including:

• 5 cases of carotid artery dissection
• 3 cases of vertebral artery dissection
• 2 cases of ischemic stroke without dissection 1

Time Considerations and Stroke Risk

The guidelines do not specify a "safe" duration for choke holds because:

1. Rapid Onset: Stroke can occur within minutes of cerebral blood flow interruption
2. Individual Variation: Susceptibility varies based on:
   • Pre-existing vascular conditions
   • Age
   • Presence of atherosclerosis
   • Hypertension (the most important modifiable risk factor for stroke) 2

Warning Signs and Emergency Response

Stroke symptoms require immediate medical attention, as treatment effectiveness depends on rapid intervention:

• For ischemic stroke, tissue plasminogen activator (r-tPA) treatment should begin within 3 hours of symptom onset for optimal benefit 3
• For hemorrhagic stroke, immediate surgical intervention is crucial to prevent rebleeding 3

Key Warning Signs (FAST)

• Facial droop
• Arm drift
• Speech difficulties
• Time to call emergency services 4

Safety Considerations

While a survey of combat sports participants reported that only 0.05% of 4,307 respondents experienced ongoing symptoms from sportive chokes 5, this self-reported data may underestimate the true risk, especially for:

• Older individuals
• People with hypertension
• Those with pre-existing vascular abnormalities
• Individuals with atherosclerosis

Clinical Implications

For healthcare providers evaluating patients with neurological symptoms following a choke:

1. Immediate Imaging: Non-contrast CT and CT-angiography should be performed immediately to differentiate between ischemic and hemorrhagic stroke 4

2. Vascular Assessment: Complete vascular imaging from aortic arch to vertex to identify potential dissections or occlusions 4

3. Time-Critical Treatment:

   • IV thrombolysis with r-tPA is strongly recommended for eligible patients within 3 hours of symptom onset 4
   • Consider endovascular therapy for large vessel occlusions 4

The critical message is that any duration of choke hold carries risk, and there is no established "safe" time limit that guarantees prevention of stroke or vascular injury.