Cerebral Angiogram – A change in Acute Stroke Management

In India, a stroke occurs once every 40 seconds and every 4 minutes somebody dies of a stroke.

Despite this being such a common and debilitating disease, the awareness among the general population is very low. Many times patients come to the health care provider several hours after the onset of stroke and hence are deprived of rescue stroke therapy.

Over the last 5 years, there have been dramatic changes in the approach and management of brain stroke (give anchor text as brain stroke) . Newer thrombolytic drugs such as Tenecteplase has been approved for the management of acute stroke in India. Endovascular treatment for stroke was initially limited to 6 hours from stroke onset. But recent studies have demonstrated that such procedures could be beneficial in carefully selected patients, even up to 24 hours after the onset of stroke.

How to identify a patient/relative suffering from a stroke?

The primary signs to detect if a patient/relative is suffering from stroke are given below:

B – Balance – sudden loss of balance

E – Eyes – loss of sight in one or both eyes

F – Face – drooping on one side

A – Arms – weakness on one side

S – Speech – slurred or lost

T – Time – to reach a hospital

Why is clot retrieval so essential in Acute Ischemic Stroke?

Figure 1 – showing a large vessel Ischemic stroke. The red area shows the tissue that is infarcted (dead). The blue area shows the ischemic penumbra that is susceptible to infarction (death). This is the tissue that can be salvaged (saved) by endovascular treatment.

What should we know about large vessel occlusions in Acute Ischemic Stroke?

• It is common – 40 to 50 % of all ischemic strokes
• It is severe – 5 times higher mortality and 3 fold reduction in a good outcome
• Responds poorly to intravenous thrombolytic therapy

Is revascularization related to a good outcome?

Why clot removal would work within 24 hours of a brain stroke ?

• Acute Ischemic stroke represents a dynamic process
• Infarct expansion does vary based on time, residual blood flow, collateral blood flow, etc.
• Tissue fate is influenced not only by the duration of ischemia but also by the severity of ischemia
• Time while accurate remains imprecise marker for brain physiology
• There is significant variance in the rate of infarct development and progression
• Advanced brain imaging remains the most readily available and valuable biomarker for stroke

R N Tagore Hospital, Kolkata provides 24/7 emergency services for all kinds of neuro-related ailments with advanced medical and interventional therapies. RTIICS is now a centre for Heart, Liver and Kidney transplantation.

Dr. Kaushik Sundar, Consultant Stroke & Interventional Neurologist, RTIICS Kolkata