Acute Ischemic Stroke Treatment
Minimally invasive treatment of acute ischemic strokes using state of the art mechanical thrombectomy techniques
Over the past decade, the treatment of acute ischemic stroke (stroke caused by a blood clot blocking off blood flow to part of the brain) has advanced tremendously. Comprehensive Neurointerventional Specialists has remained at the forefront of this advancement, working on a daily basis to improve the quality and speed of emergency stroke care provided at Ascension Borgess Hospital. To learn more or ask questions, simply reach out.
What is an Acute Stroke?
A stroke is a generic term indicating the sudden onset of a new neurologic deficit, regardless the cause. The most common causes are when a blood clot blocks off blood flow to a portion of the brain (ischemic stroke) and when bleeding into the brain occurs (hemorrhagic stroke), although many other conditions can mimic a stroke.
Diagnosis of an Acute Ischemic Stroke
Initial diagnosis of an acute stroke is based on the patient or someone they're with recognizing that the patient has developed a new neurologic deficit, such as face, arm, or leg weakness, difficulty speaking, vision changes/gaze deviation to one side, neglect of one side of the body, or dizziness. In this situation, it is imperative that the EMS be called, and the patient be taken immediately to the nearest stroke center. Once at the stroke center, a neurological exam will be performed, and the patient will be sent for advanced imaging (usually CT) as quickly as possible.
CT, CT Angiography, & CT Perfusion
Advanced imaging techniques using radiation to create high resolution image slices through the head and neck; CT angiography scans allow us to see blocked arteries; CT perfusion scans allow us to see what areas of the brain are at risk of being damaged due to blocked arteries
MRI, MR Angiography, & MR Perfusion
Advanced imaging techniques using strong magnetic fields and RF energy pulses to create high resolution image slices through the head and neck that can identify areas of the brain that have already been damaged by the stroke; MR angiography scans allow us to see blocked arteries; MR perfusion scans allow us to see what areas of the brain are at risk of being damaged due to blocked arteries
Cerebral Angiography
Minimally invasive image-guided surgical procedure in which a catheter is advanced from the groin or wrist to the neck, and contrast dye is injected while X-rays obtain high resolution pictures of the blood vessels in the head and neck; gold standard technique for evaluating the blood vessels in the head and neck and also allows for treatment of the stroke at the time of angiography
Treatment of Acute Ischemic Stroke
Historically, acute ischemic stroke was not considered an emergency, and it was treated with conservative medical management that may include removal of a portion of the skull (craniotomy) in order to relieve brain swelling in severe strokes.
In the mid 1990s, tPA (a clot busting medication) was approved by the FDA for the treatment of acute ischemic stroke. Currently, tPA and other similar medications are administered if someone arrives to the hospital within 3-4.5 hours of the onset of stroke symptoms as long as they don't have any contraindications to receiving the medication.
Beginning in 2014, studies have shown that mechanical thrombectomy (opening of a blocked artery using catheters and a variety of assistive devices) is effective at opening blocked arteries in the head and neck and improving patient outcomes. Today, the most common techniques used are aspiration only and aspiration combined with the use of stent retrievers.
Aspiration Thrombectomy
A clot is aspirated from a blocked artery using a catheter attached to an aspiration pump.
Aspiration Thrombectomy with a Stent Retriever
A clot is aspirated from a blocked artery using a stent retriever to pull the clot into a catheter attached to an aspiration pump.
Treatment of Acute Hemorrhagic Stroke
When a patient has a stroke caused by bleeding into the brain, the treatment depends entirely on the location of the bleeding and the presumed cause. If the bleeding is believed to be caused by a ruptured brain aneurysm, then the aneurysm will be treated urgently by embolization, most commonly using coils with or without a stent. If the bleeding is non-aneurysmal, then the patient's care will usually be managed by an open neurosurgeon rather than a neurointerventionalist.
Treatment of a Ruptured Brain Aneurysm
The ruptured brain aneurysm is closed by inserting metallic coils with or without placement of a stent to hold the coils in the aneurysm.
