Emergency Surgical Stroke Treatment: Neurointerventional Procedures
Microcatheter-based surgical interventions for stroke may include the use of a small microcatheter, delivered through a larger guiding catheter inserted at the groin through a small incision. A microguidewire is used to navigate the microcatheter to the site of obstruction in the brain. Thrombolytic medication, such as tPA, can then be administered directly to the occluding thrombus. This kind of treatment, which delivers thrombolytic medication intraarterially, is more specific than IV tPA and consequently may require significantly lesser dosages of medication. The time limit to implement this type of intervention is also significantly longer than that for IV TPA. Generally, only Comprehensive Stroke Care Centers offer this type of treatment.
Will I Have Another Stroke
One of the biggest worries for many people is whether they will have another stroke. This can be part of the emotional impact of stroke on you, your family and friends. But it can help to know that when you have a stroke, one of the main aims of your hospital team is to stop you having another stroke.
Brain scans and other test and checks find out what caused your stroke and allow doctors to target your treatment. After an ischaemic stroke, you will be given medicine to avoid blood clots forming. If you have a health condition linked to stroke such as high blood pressure, you will be given any treatment and advice that you need to help you avoid another stroke.
Having a stroke or TIA means that you are at greater risk of having another stroke. The risk is highest in the days and weeks after a stroke, which is why doctors work so hard to reduce your risk early on.
In the months and years after a stroke, you could help to keep your risks low by following the treatments for your health conditions, and making healthy lifestyle changes.
When you have a stroke, doctors check you for any health conditions linked to stroke. These health conditions include:
How Is An Ischaemic Stroke Treated
The main treatments aiming to break up or remove clots from the brain are usually only available within a few hours of a stroke. But there is also a range of other types of care, including medication to reduce your blood pressure and reduce your risk of another stroke. You will be monitored for signs of complications and given any treatment you need. You will be assessed to find out how the stroke has affected you, and what help you need with your recovery.
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What Are The Causes
Risk factors you can’t modify
- Age – as a person ages, the chance of stroke increases.
- Gender – men are more likely than women to experience a stroke.
- Race – African Americans face twice the risk of stroke as Caucasians, while Hispanics are more likely to suffer a stroke at a younger age than non-Hispanic Caucasians.
Risk factors you can modify
- High blood pressure – this is the most dominant stroke risk factor and the easiest to modify. Check your blood pressure regularly and keep it under control.
- Smoking – tobacco use doubles your stroke risk. If you smoke, stop.
- Weight – Being overweight predisposes you to high cholesterol, high blood pressure, and diabetes, all of which increase stroke risk. If you are overweight, modify your diet and limit your intake of fatty foods.
- Diabetes – makes people susceptible to cardiovascular diseases, which can result in stroke. If you have diabetes, keep it well controlled.
- Prior stroke or TIA – increases your risk of having another stroke. Certain medications may decrease stroke risk if taken regularly.
- Heart disease – heart conditions, especially atrial fibrillation , increase stroke risk. Certain medications may decrease the risk if taken regularly.
Symptoms Of Blood Clots
Blood clots can cause various symptoms depending on where they form in the body. They can reduce or block blood flow for a few seconds or longer.
A blood clot can affect any area of the body, but some regions are more susceptible to blood clots than others.
The most common symptoms and regions of a blood clot are:
- In the arms or legs: Deep vein thrombosis causes swelling in the affected limb.
- In the heart: A heart attack can cause shortness of breath, chest pain, arm pain, jaw pain, or indigestion.
- In the brain: A stroke or transient ischemic attack can cause vision or language impairments, as well as numbness or weakness on one side of the face or body.
- In the intestines: Intestinal ischemia can cause abdominal cramping, pain, and digestive problems.
- In the kidneys: A blood clot in the kidney can cause loss of kidney function, which may cause decreased urination, blood in the urine, and electrolyte imbalances .
- In the lungs: A blood clot in the lungs is called a pulmonary embolism , and it causes shortness of breath and difficulty breathing.
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Causes Of Blood Clots
The process of blood clot formation involves platelets and proteins. Platelets are a type of blood cell produced in the bone marrow. Injuries, such as a cut, trigger the accumulation of platelets and coagulation proteins to close off a wound, which prevents blood loss and gives the injured area a chance to heal.
Harmful blood clots, such as blood clots in the hearts blood vessels or the peripheral blood vessels , can form due to diseases that provoke atherosclerosis, tissue injury, inflammation, or an abnormality of the blood clotting process. Atherosclerosis is a type of damage inside the blood vessel walls.
Risk factors for harmful blood clots include:
- Major physical trauma with extensive bleeding
- During hospitalization, due to immobility
Sometimes treatment is used to prevent a blood clot. For example, during hospitalization, some people are given low-dose injections of heparin to prevent a DVT.
What Happens In The Brain During A Stroke
The brain controls our movements, stores our memories, and is the source of our thoughts, emotions, and language. The brain also controls many functions of the body, like breathing and digestion.
To work properly, your brain needs oxygen. Your arteries deliver oxygen-rich blood to all parts of your brain. If something happens to block the flow of blood, brain cells start to die within minutes, because they cant get oxygen. This causes a stroke.
Learn more about the signs and symptoms of stroke.
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What Complications Can A Stroke Cause
A stroke is a medical emergency for a reason it can have life-threatening consequences. The brain controls the major functions of human life. Without blood flow, your brain cant manage breathing, blood pressure, and much more. Complications can vary according to the stroke type and if you are able to successfully receive treatment. Examples of complications include:
Behavior changes: Having a stroke can contribute to depression or anxiety. You also may experience changes in your behavior, such as being more impulsive or more withdrawn from socializing with others.
Speech difficulties: A stroke can impact areas of your brain having to do with speech and swallowing. As a result, you may have difficulty reading, writing, or understanding other people when theyre speaking.
Numbness or pain: A stroke can cause numbness and decreased sensation in parts of your body. This can be painful. Sometimes injury to the brain can also affect your ability to sense temperature. This condition is known as central stroke pain and can be difficult to treat.
Paralysis: Because of the way your brain works to direct movement, a stroke in the right side of your brain can affect movement on the left side of your body and vice-versa. Those whove had a stroke may not be able to use facial muscles or move an arm on one side.
You may be able to regain lost motor function, speech, or swallowing abilities after a stroke through rehabilitation. However, these can take time to regain.
How Is A Diagnosis Made
When an individual is brought to the emergency room with an apparent stroke, the doctor will learn as much about the patient symptoms, current and previous medical problems, current medications, and family history. The doctor also will perform a physical exam. If the patient can’t communicate, a family member or friend will be asked to provide this information. Diagnostic tests are used to help the doctors determine what is the cause and how to treat the stroke.
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Which Treatment Is Suitable For My Condition
The aim of the treatment is to remove the blood clot from the artery. This can be either done by medical treatment and/or endovascular approach . Treatment options are varying from each case. Factors such as: location, size, and condition play a major role for the chosen treatment.
The endovascular approach is a treatment from within the vessel. It is a minimally invasive procedure which typically only requires a puncture of the groin. Small catheters are navigated through the artery towards the blockage. Treatment devices can be delivered through these catheters.
What Are Recurrent Strokes
Recurrent strokes occur in about 1 in 4 people who have had a stroke within 5 years after a first stroke. The risk is greatest right after a stroke and decreases over time. The likelihood of severe disability and death increases with each recurrent stroke. About 3% of people who have had a stroke have a second stroke within 30 days of their first stroke, and about one-third have a second stroke within 2 years.
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What Is A Tia
A transient ischemic attack occurs when a blood clot blocks an artery for a short time. The symptoms of TIA are the same as the stroke symptoms but last only for a few minutes or hours. A TIA is a sign that you are at risk for a major stroke in the next few days or weeks. If you have symptoms of a TIA call 911 immediately.
How Does The Covid
The effects of the pandemic may mean that some people in hospital for a stroke may leave earlier than usual. They may also have problems accessing care acutely or after leaving the hospital. This may affect services such as rehabilitation resources, such as physiotherapy and neurorehabilitation therapy.
However, they should still get the support and treatment they need from their healthcare team or stroke center, with a detailed care plan. Some treatments may need to happen at home, while appointments may happen over phone or video calls.
Stroke survivors are vulnerable to severe COVID-19. That means survivors, and those who care for them, should take extra precautions and care in maintaining hygiene and physical distancing. Washing hands and cleaning surfaces and items that others have touched is important. A stroke survivor may also wish to get a COVID-19 vaccine.
Health experts also advise staying at home whenever possible. Stroke survivors may wish to ask a family member or friend to undertake essential tasks outside the home, such as grocery shopping or pharmacy trips. They should also work from home where possible and avoid situations in which physical distancing is difficult to maintain.
Wearing a mask helps to protect you and others around you. Stroke survivors should wear a mask when venturing outdoors and avoid anyone not wearing one.
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Other Checks And Tests
Your blood pressure is checked, and you have blood tests for health conditions linked to stroke, such as diabetes and high cholesterol.
You may have other tests to check for conditions that could have contributed to your stroke. These include an electrocardiogram , which checks for an irregular heartbeat, or a Doppler ultrasound scan to check for narrowing of the blood vessels in your neck.
Emergency Treatment In Case Of Stroke
Having a stroke is an emergency situation. If you experience it, then you should contact emergency services immediately, without any delay. If you receive quick treatment, then the chances of your recovery are higher and you are more likely to survive. There are different emergency treatments, and they depend on the type of stroke.
Even a small blood clot in the brain can result in ischemic stroke. When you have an ischemic stroke, the doctor will try to dissolve the clot. Usually, aspirin is given to ensure that there is no further formation of clots. Otherwise, clot-busting drugs such as thrombolytics will be provided, in the case of ischemic stroke. Other types of emergency treatment can be mechanical thrombectomy. This is the use of catheters to remove the clot from the affected artery. This medical procedure can take place a day after stroke symptoms appear. Sometimes, surgery may be necessary to ensure the pressure in the brain is reduced.
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Are You At Risk
The following are some of the factors that make you vulnerable to a stroke.
- If you have a family history of someone who had a stroke, then you are quite likely to get a stroke.
- People who are 65 or older are more prone to a stroke, although younger people can have a heart stroke, as well.
- Any medicine that is used for blood thinning increases your chances of having a stroke. Medicines such as Warfarin and Apixaban are prime examples.
- People who have had a stroke before, are likely to have a stroke again.
- People in ethnic groups such as Alaska Natives, Hispanic descent, native Americans, and African-Americans are more likely to have a stroke.
- Strokes affect more men than women, although it is more likely to affect women more severely than men.
- You are more likely to have a stroke if you donât exercise, use drugs, regularly smoke, or drink alcohol regularly.
- Obese people are at risk of having a stroke.
- Women who are pregnant can experience a stroke. Women who have taken birth control pills are highly likely to have a stroke too.
- People who have conditions such as PCOS, sickle cell disease, diabetes, brain tumours, migraines, and conditions associated with excess bleeding are more prone to stroke.
- People who have vascular or heart problems are more at risk of stroke.
What Treatments Are Available
Treatment for stroke depends on whether the patient is diagnosed with an ischemic or hemorrhagic stroke. In either case the person must get to a hospital immediately for the treatments to work.
Ischemic stroke treatments can be divided into emergency treatments to reverse a blockage and preventive treatments to prevent stroke.
Clot buster drugs Thrombolytic âclot-busterâ drugs help restore blood flow by dissolving the clot that is blocking the artery. The most common âclot-busterâ drug is tissue plasminogen activator, or tPA for short. TPA is an enzyme found naturally in the body that dissolves clots. Doctors inject extra tPA into the bloodstream to speed up this process. To be effective, tPA should be given as quickly as possible. Patients who received tPA within 3 to 4 hours of onset of stroke symptoms were at least 33% more likely to recover from their stroke with little or no disability after 3 months .
- A stent retriever is a wire mesh tube, like a stent, that is attached to a long wire. When the tube is opened in the blocked artery, the clot gets stuck in the mesh. The doctor then pulls out the mesh using the long wire, pulling out the clot with it.
- An aspiration catheter is like a vacuum cleaner that is attached to a special suction unit and used to suck out the clot.
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Greater Risk Of Stroke
Patients who present to hospital with COVID-19 are also more likely to have a stroke when compared with the general population.
Typically, the chance of having a stroke is associated with increasing age, as well as other risk factors such as high blood pressure, elevated cholesterol levels, or smoking.
However, higher rates of strokes in patients with COVID-19 is somewhat unusual because it also seems to be happening in people under 50 years of age, with no other risk factors for stroke.
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What Is An Ischaemic Stroke
An ischaemic stroke happens when a blockage cuts off the blood supply to part of your brain, killing brain cells. Damage to brain cells can affect how the body works. It can also change how you think and feel.
Its the most common type of stroke, and around 85% of strokes in the UK are ischaemic strokes. The other 15% of strokes are due to bleeding in or around the brain, known as haemorrhagic stroke.
A transient ischaemic attack is the same as a stroke but the symptoms only last for a short amount of time. It is a major warning sign of a stroke and should always be taken seriously. For more information about the signs of stroke and TIA turn to Spotting the signs of stroke near the end of this webpage.
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What Complications Can Blood Clots Cause
Having a blood clot can lead to some potentially serious complications, such as:
- Stroke. A blood clot can block blood vessels in your brain, interrupting blood flow and leading to a stroke. If a clot temporarily reduces blood flow, you can have a transient ischemic attack , or ministroke.
- Pulmonary embolism. A pulmonary embolism is when a blood clot travels to your lungs and blocks the flow of blood. This can decrease oxygen levels and damage lung tissue.
- Heart attack. A heart attack happens when blood flow to your heart tissue is cut off. Blood clots are a potential cause of heart attacks.
Its also possible that a blood clot could restrict blood flow in other parts of your body, causing potentially serious damage. Some examples of other areas that a blood clot may affect include your: