Suddenly somebody is having difficulty speaking, part of their face unexpectedly droops and one arm weakens - you might be alarmed and will call an ambulance.

Most likely you have witnessed the beginning of a stroke.

According to the American Heart Association (AHA) and the American Stroke Association (ASA), 87% of strokes results from blood vessel blockage that impedes blood flow in the brain.

They are called ischemic strokes and are less fatal than haemorrhagic strokes, in which blood leaks into brain.

Ischemic stroke occurs when a clot physically hampers blood flow.

The clot can be formed either at the ischemic zone (area of the stroke) or elsewhere, in which case, it detaches and travels through the bloodstream until it reaches a blood vessel too small to pass.

When it comes to stroke treatment, time is of utmost essence.

Standard, lifesaving procedures always start with intravenous administration of a protein that helps to dissolve the blockage. The substance is called Recombinant Tissue Plasminogen Activator (r-tPA) and should be delivered as soon as it is possible, ideally within 4.5 hours of stroke onset.

By improving blood flow, this protein lowers the side effects of stroke, minimising brain inflammation and damage.

In June this year, AHA and ASA published new guidelines for endovascular (inside blood vessels) treatment of patients in acute ischemic stroke conditions.

These are conditions in which the clot sizes are larger and often the r-TPA protein treatment is ineffective in restoring blood flow to the brain.

Therefore, this has led to further efforts in tackling such acute stroke conditions. In this new procedure, clots can be 'mechanically' removed from the large artery inside the skull.

During this procedure, a new device called stent retriever (which is similar to a tube) is introduced through a groin puncture and then guided towards the affected area. When it reaches the clot, the device self expands into a 3-dimensional mesh tube, grabs it and brings it out of the circulatory system.

Importantly, the treatment has to be started within 6 hours of stroke onset and can only be performed on patients that fulfil all the necessary criteria.

Recently stent retrievers of new design got FDA approval and with the new AHA/ASA guidelines they are getting introduced to stroke treatment routines.

Dr. Colin Derdeyn,Vice chair of AHA, Director for the Stroke and Cerebrovascular Center at Barnes-Jewish Hospital, one of the co-authors of the document, comments, "The care of stroke patients is a team sport. These guidelines will help make sure that all patients eligible are able to get this treatment, as systems change to do a better job of identifying patients with large vessel blockages and getting them quickly to places that can do these procedures."

Interestingly, the new American regulations are already in use in Europe.

"Many stent retrievers were pioneered in Germany" says Dr. Derdeyn and adds "Many other European countries already have very centralised dedicated hospitals for neuro-emergencies including stroke. Germany is ahead of the curve for this."

 

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