Stroke is the fifth leading cause of death in the United States and the leading cause of adult disability – but what is a stroke?
In its simplest terms, a stroke is the loss of blood flow to a part of the brain. That loss of blood flow can have two primary causes:
- The blockage of a blood vessel – this is called an Ischemic Stroke
- Bleeding within the brain due to a burst aneurysm or leaking blood vessel – this is called a Hemorrhagic Stroke and is less common than Ischemic strokes (about 15% of all strokes)
Regardless of the cause, the effects of a stroke can be devastating. Without proper blood flow, brain cells begin to die, and the risk of permanent disability or even death, increases every minute.
For the most common form of stroke, Ischemic (about 87% of all stroke cases), two types of therapies are used – a medication therapy, or mechanical removal (used with medication).
- Considered the gold standard, tissue plasminogen activator (or Alteplase IV r-tPA), also known as tPA, is the only FDA-approved treatment for ischemic strokes.
- When promptly administered, it can save lives and reduce the long-term effects of stroke. It works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. tPA needs to be used within three hours of having a stroke (or up to 4.5 hours in certain eligible patients).
- Many people miss this key brain-saving treatment because they don’t arrive at the hospital in time for tPA treatment, which is why it’s so important to identify a stroke, and seek treatment immediately for the best possible chance at a full recovery.
The physical removal of a large blood clot, called an endovascular procedure or a mechanical thrombectomy, is another treatment option. Patients must meet certain criteria to be eligible for this procedure, and it should be done within six hours of acute stroke symptoms, and only after a patient receives tPA.
- Thrombectomy allows trained doctors to use a wire-cage device called a stent retriever to remove a large blood clot.
- To remove the clot, doctors thread a catheter through an artery in the groin up to the blocked artery in the brain. The stent opens and grabs the clot, allowing doctors to then remove the stent with the trapped clot.
- Special suction tubes may also be used to remove the clot.
For Hemorrhagic Strokes, mechanical treatment to stop the bleeding is required.
- A small tube called a catheter may be threaded up through a major artery in an arm or leg and guided into the brain tissue, allowing the surgeon to use camera technology to help fix the problem.
- Once the catheter is guided to the source of the bleeding, it deposits a mechanical agent, such as a coil, to prevent further rupture. This type of procedure is endovascular, meaning that the surgeon gains access via the vascular system, making it less invasive than conventional surgical treatment.
- Sometimes surgery is required to secure a blood vessel at the base of the aneurysm.