May 26, 2020
As the number five cause of death in the U.S.—and the leading cause of serious long-term disability—stroke affects hundreds of thousands of Americans each year. Strokes are a sudden injury to the brain caused by problems with the blood vessels. There are two main types of strokes: a hemorrhagic stroke can happen when a blood vessel or brain aneurysm ruptures. The more common ischemic stroke occurs when a blood vessel is blocked, usually by a clot. During a stroke, the interruption of blood to the brain starves cells of needed oxygen and neurons are damaged—around two million a minute.
“We say that ‘time is brain’ because damaged neurons can’t regenerate,” said Dr. Krishna Amuluru, one of our interventional neuroradiologists. “That’s why we work so hard to improve our time to recanalization.” Recanalization, in this case, is the restoring of blood flow through the affected vessel.
Getting Treatment for Stroke F-A-S-T
Getting medical attention early is critical with stroke, which is why it’s important to know the signs that stroke is occurring. The acronym FAST is an easy way to remember the signs—and the importance of acting quickly. FAST stands for:
- Face drooping
- Arm weakness
- Speech difficulty
- Time to call 9-1-1
When you recognize any of these symptoms, call for help right away. The faster you get to the ER, the faster you can get treatment to recanalize the affected blood vessel and restore blood flow to the brain.
Depending on symptoms and severity, a medication called a tPA (tissue plasminogen activator) may be sufficient to restore blood flow, and in these cases a procedure may not be necessary. But for many patients with the most common kind of stroke—the ischemic type involving a vessel blockage—recanalization requires a procedure called a mechanical thrombectomy, in which the clot (or thrombus) must be physically removed from the blocked vessel.
The recanalization clock starts with catheterization, the insertion of a slender tube and wire in a blood vessel of the patient’s arm or leg. Using a real-time X-ray machine, surgeons guide the wire to the site of the blockage. A tiny device called a stent retriever—“It acts like a fishing net,” Amuluru explained—is used to capture the clot, which is then pulled free. The time between catheterization and removal of the clot is the “time to recanalization.”
“Any time under 30 minutes is fantastic, but we’re always trying hard for the best possible time,” said Amuluru. “Our average time is probably 20 to 25 minutes, and our fastest might be 15 minutes.”
After a thrombectomy, patients are monitored closely in an inpatient setting, and in addition to managing any complications, the focus of care turns toward treating the underlying conditions that may have led to the stroke and preventing future strokes from occurring.
“If you have one stroke, you may be more likely to have another,” said Amuluru. “Some of the major controllable factors we look at in preventing stroke are blood pressure, diabetes, diet, exercise, and smoking.”
There are a number of medications that can help prevent future clots from forming—one of the most common being aspirin. But lifestyle changes, particularly those to reduce your blood pressure, are important, too. Changes to diet and exercise, as well as quitting smoking, can make a big difference if you’re at risk for stroke—whether or not a stroke has already occured.