Every Minute Counts in Stroke Treatment

By Sunil Rayan, M.D., Scripps Memorial Hospital La Jolla

The devastating effects of one of the most deadly and debilitating health problems could be significantly reduced through quick action and advanced medical techniques.

Stroke is the third leading cause of death in the country, and can lead to a number of serious disabilities including loss of speech, weakness or paralysis, coordination problems, confusion, and memory loss.Every 45 seconds, someone in the United States has a stroke. And when it happens, immediate action is crucial. Stroke victims who receive emergency care within the first three to six hours of the first symptom may avoid or greatly lessen the consequences to their health.

What is Stroke?
A stroke is an interruption of blood flow to the brain, most often caused by a clot in an artery that feeds the brain. In most stroke cases, the clot forms elsewhere in the body and migrates to the brain; in some cases, the blood clot is in the brain itself. When blood flow is cut off, brain cells cannot get the oxygen and other nutrients they need to survive. If they die, the part of the body they control is affected as a result. Fortunately, brain tissue doesn’t die right away. If blocked blood vessels can be opened within three to six hours, there is a significant chance of recovery. But every minute counts.

Taking Action: Interventional Radiologists
When a patient comes to the emergency room after suffering stroke, a team of emergency room physicians, neurologists, and interventional radiologists goes into action. Interventional radiologists are physicians who specialize in treating diseases using small catheters and catheter-based instruments guided by radiological imaging techniques such as X-rays, ultrasound, and Magnetic Resonance Imaging (MRI). Performed under local anesthesia, this minimally invasive approach reduces the need for large surgical incisions and general anesthesia.

In order to deliver the proper treatment, the stroke team must first establish the nature of the stroke. The interventional radiologist interprets the patient’s CT (computed tomography) scan to determine the cause; if it is a blood cot, the interventional radiologist will administer a clot-busting drug through a catheter inserted into a tiny incision at the groin. With the help of X-ray guidance, the interventional radiologist passes the catheter through an artery in the leg to the tiny arteries in the brain to break up the clot. When delivered within hours of the first sign of stroke, this treatment often enables stroke patients to return to their normal lives with minimal or no disabilities.

In some cases, stroke may be caused by narrowed carotid arteries (a condition known as atherosclerosis). A buildup of plaque in the artery may decrease blood flow to the brain, or break loose and block a smaller vessel leading to the brain. In these cases, the interventional radiologist may re-open the narrowed artery by removing the plaque, and then insert a stent to keep the pathway open. This treatment may also be used to prevent stroke in patients who have blocked arteries.

In cases when stroke is caused by a ruptured aneurysm that bleeds into the brain (a condition called hemorrhagic stroke), the interventional radiologist may use an X-ray- guided catheter to deliver a drug called an embolizing agent that clots the blood or closes off the broken vessel. Tiny platinum coils may be left in the vessel to block abnormal blood flow. This technique may also prevent stroke by treating aneurysms before they rupture.

Advantages of Interventional Radiology
The advanced techniques of interventional radiology offer several significant advantages over treatments used in the past. Until the FDA approved the platinum coil device used to treat hemorrhagic stroke in 1995, surgery had been the conventional treatment.Studies have shown that minimally invasive interventional techniques substantially reduce the risk of severe disability or death compared to surgery in patients who are candidates for both procedures. There is far less likelihood of surgical complications such as nerve injury and wound infection.

In addition, interventional radiology can treat narrowed arteries that are difficult to access surgically. And, because these techniques are minimally invasive, they take less time and are less painful for patients, and recovery times are generally faster.

Is It Stroke?
Unfortunately, many stroke victims do not recognize the signs of stroke, or wait too long to call a doctor. Stroke symptoms come on very suddenly and can include the following:

  • Numbness or weakness on one side of the body
  • Confusion or problems talking or understanding speech
  • Difficulty seeing with one or both eyes
  • Difficulty walking, dizziness, or lack of coordination
  • Severe headache

If you think you are having a stroke, go to the emergency room immediately. It is always better to find out you didn’t have a stroke than to learn you did and waited too long to get help.

Sunil Rayan, M.D., is a vascular surgeon at Scripps Memorial Hospital La Jolla.