Stroke is also called as “BRAIN ATTACK”. Every 1 in 6 people worldwide will have a stroke in their lifetime. Typically, a stroke is identified by sudden onset weakness of upper or lower limbs, slurring of speech, facial asymmetry/salivary drooling, sudden onset unconsciousness, sudden unresponsiveness. Stroke can be hemorrhagic or ischemic. Time is brain, as soon as stroke is identified, immediately shift to a hospital where advanced intervention techniques are available for optimal treatment. Under ideal circumstances, patient has to reach hospital within 6 hours for optimal treatment.
Typically, a stroke is identified by sudden onset weakness of upper or lower limbs, slurring of speech, facial asymmetry/salivary drooling, sudden onset unconsciousness, sudden unresponsiveness. Stroke can be hemorrhagic or ischemic. Time is brain, as soon as stroke is identified, immediately shift to a hospital where advanced intervention techniques are available for optimal treatment. Under ideal circumstances, patient has to reach hospital within 6 hours for optimal treament.
Treatment of large vessel blockage:
Intra-arterial (IA) Thrombolysis
Activase (blood clot lysing agent) can also be used for intra-arterial thrombolytics, in which the medication is delivered directly to the clot. A catheter is inserted into an artery in the groin and threaded to the blocked artery in the brain. The clot-busting drug is then injected directly into the clot. Many times, IV thrombolysis can be used to bridge dealy in performing IA thrombolysis.
Mechanical Embolectomy
Mechanical embolectomy is a procedure used to open the intracranial vessels during an ischemic stroke by removing a blood clot from the artery with a small instrument. Mechanical embolectomies are frequently performed on patients who are not eligible for intravenous or intra-arterial thrombolysis. The clot is either directly aspirated or is retrieved . Recent trials have shown high success rate of this technique, which is believed to replace other modalities of treatment for hyperacute stroke in future.
However, physiology of cerebral ishemia/infarct varies from person to person. Hence at times a person reaching within 6 hours could not be treated due to extensive brain damage, while in some patients significant salvagable brain tissue may be possible upto 8 hours or rarely even more. Imaging aspects like MR/CT perfusion may aid in proper selection of such patients.
