Treatment of stroke

Stroke treatment involves immediate interventions like thrombolysis and thrombectomy, neurosurgical procedures, and supportive care, followed by long-term risk factor management. This article delves into these strategies, outlining their significance in stroke recovery and future stroke prevention.

Thrombolysis

Thrombolysis, a procedure involving the dissolution of blood clots, plays a crucial role in the treatment of acute ischemic stroke. It is especially effective when administered within the first three hours of symptom onset. Using recombinant tissue plasminogen activator (rtPA), a 10% overall benefit regarding living without disability can be achieved, although this treatment does not improve chances of survival. The sooner it’s administered, the greater the benefits.

However, the effect of thrombolysis becomes less certain when administered between three and four and a half hours after symptom onset. Beyond four and a half hours, thrombolysis can result in adverse outcomes. Certain patients with findings of salvageable tissue on medical imaging between 4.5 hours and 9 hours after symptom onset, or those who wake up with a stroke, may still benefit from alteplase treatment.

Endorsements for the use of thrombolysis come from reputable organizations such as the American Heart Association, the American College of Emergency Physicians, and the American Academy of Neurology. It’s worth noting that 6.4% of patients with large strokes could experience substantial brain bleeding as a complication of rtPA administration, contributing to increased short-term mortality.

Intra-arterial fibrinolysis, where a catheter is passed up an artery into the brain and the medication is injected at the site of thrombosis, can also enhance outcomes in people with acute ischemic stroke.

Thrombectomy

Thrombectomy is a surgical procedure for removing a blood clot. In mechanical thrombectomy, the procedure involves using a special retrieval device to remove the clot and restore normal blood flow. If the clot is removed before it causes permanent damage, the prognosis usually improves. It’s performed globally in specialist hospitals and is suitable for many, but not all, stroke patients.

Risks associated with mechanical thrombectomy include potential failure to retrieve the clot, potential allergic reactions to contrast dye agents, and potential kidney dysfunction resulting from the excretion of the contrast agent. Additionally, the procedure requires general anesthesia, posing its own risks. More serious, but rarer, complications include severe brain injury, post-procedure brain bleeding, and radiation-induced health issues.

Mechanical thrombectomy is usually considered an emergency and potentially life-saving treatment. An alternative to thrombectomy is the administration of a ‘clot-busting’ thrombolytic drug, although this option may not be as effective or suitable for all patients due to various risk factors.