Early administration of Clot-busting medication after Stroke is crucial in saving lives and preventing long-term disability (Time is Brain)

Stroke is the third leading cause of death and the leading cause of major disability worldwide. A stroke, otherwise called ‘Brain Attack’, is a sudden loss of brain function and injury to part of the brain resulting from damage to the blood vessels supplying the brain. There are two main types of stroke, those associated with rupture of the blood vessels (haemorrhagic strokes) and those associated with the blockage of blood vessels (ischemic strokes).

In an acute ischemic stroke, the blood flow to a part of the brain is interrupted due to sudden blockage of a blood vessel. The blockage is usually due to a blood clot and starves the brain of oxygen and nutrients. The centre of this damaged area, called infarct, may die quickly and the surrounding area may die slowly over hours.

TPA (Tissue Plasminogen Activator) is a medication injected into a vein that can dissolve blood clots. If the clot is dissolved soon enough, the blood supply is restored, preventing further injury to the brain and function preserved. The benefit of thrombolytic treatment decreases with time.  Every minute in which a large vessel ischemic stroke is untreated, the average patient loses 1.9 million neurons (nerve cells) and 13.8 billion synapses (the connection between nerve cells). Putting it simply, Time is Brain after a stroke. Every second counts.

Treatment with clot-busting medication doubles the odds of being normal or nearly normal. This benefit comes with some increased risk of bleeding in the brain and occasionally even death. The chance of serious bleeding is about 1% in stroke patients not treated with tPA versus 6% in those who receive TPA.  However, this risk is clearly outweighed by the benefits of the treatment, provided it is given early.

If patients arrive at the hospital too late for the administration of IV tPA  (‘outside the window period’) or if IV tPA is not appropriate for them, physicians may remove the clot mechanically (‘Mechanical Thrombectomy’) with neuro-interventional techniques. This involves navigating a small catheter (a hollow tube) through the blood vessels to the location of the blockage. A device can then be used to suction the clot (aspiration) or trap the clot and remove it (retrieval). It can even be beneficial for up to 24 hours from the start of symptoms in certain situations. Mechanical thrombectomy for stroke is a highly specialized treatment and should only be performed at hospitals with experienced neuro-interventional teams.

Early recognition of symptoms of stroke is crucial so that one can report to a stroke care unit and life-saving treatment can be started with minimum delay. BE-FAST (Balance problems, Eyes – double vision, Face – drooping, Arm weakness, Speech difficulty, and Time (importance of reaching the hospital early when one notices any of these symptoms) is an acronym that everyone must remember.

 

Dr (Lt Gen) CS Narayanan
 

HOD And Consultant - Department Of Neurology

Manipal Hospitals Dwarka
 

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