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  • Writer's pictureOren Zarif

Surgery for the Treatment of Stroke - Oren Zarif - Treatment of Stroke

There are two major types of surgery for the treatment of stroke. Thrombolytic therapy and mechanical thrombectomy both require expertise in vascular and brain imaging. A thrombolytic drug, such as alteplase (tPA), is injected into a vein to dissolve the clot. The drug gradually reduces its effect over a few hours. Early thrombolytic therapy is most successful. It can save the patient's life.

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Acute therapies for ischemic stroke have the potential to improve neurologic and functional outcomes, although only one is currently approved. This treatment is an intravenous TPA (tissue-type plasminogen activator), and must be administered within three hours of the onset of the stroke. In a single trial, intra-arterial prourokinase can improve outcome but has not been approved for general use. New understanding of focal ischemic brain injury led to the development of numerous neuroprotective drugs.

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TPA is an anti-clotting drug that is given to patients within three to four hours of the onset of stroke symptoms. It dissolves blood clots quickly and helps minimize disability after stroke. Patients who receive tPA treatment are more likely to recover from their stroke than patients who did not receive it. tPA is also available in the form of a surgery called catheterectomy.

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This surgery involves inserting a catheter into a large blood vessel in the head and removing the clot. The results from the NINDS study show that both tPA and placebo have favorable effects, however the latter treatment does not have proven to be as effective as the former.

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Early recognition of the onset of stroke symptoms is crucial for the best possible treatment. If the symptoms occur within four hours of the stroke, treatment is possible, but only if the patient arrives at the hospital quickly enough. TIAs, also called mini-strokes, may progress to full-blown stroke if not treated. For this reason, it is imperative to seek emergency medical attention. Without prompt treatment, the patient may suffer irreparable brain damage.

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Antiplatelet therapy is a common first-line drug for the treatment of acute ischemic stroke. It inhibits platelets, which stick to damaged areas of blood vessels and form blood clots. By blocking the activity of antiplatelets, aspirin can prevent another stroke and reduce the risk of future occurrences. However, aspirin should not be given within 24 hours of rt-PA. It is important to consult a cardiologist before starting any anticoagulant treatment.

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Other causes of ischemic stroke include coronary artery disease, pulmonary embolism, and dissection of neck or thoracic arteries. In these instances, blood flow to the brain is blocked, resulting in a stroke. The symptoms of transient ischemic attacks can be similar to those of a full stroke, except they disappear when the blockage moves. These strokes may be caused by a variety of factors, including lack of exercise.

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Various tests are often used to determine the cause of stroke. A CT scan (also known as carotid duplex scan) gives doctors a detailed view of the brain. It can also help detect clots in the heart that traveled to the brain. Electrocardiograms can also show if a clot is affecting the heart, which may have contributed to the stroke. Thrombolytic drugs may be used to dissolve clots that have accumulated in the carotid arteries.

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Neuroprotective drugs have been studied for years and seem to be effective in many preclinical models of stroke. Unfortunately, they have not yet been proven effective in humans. These studies have largely been unsuccessful, but they cemented the tradition of clinical stroke research. They also provided training for the first clinical research coordinators, which subsequently drew significant financial support to stroke programs around the world. Furthermore, NIH has made the search for an effective acute stroke therapy their number one priority.

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