Stroke: a Q & A with our director of endovascular neurosurgery
Every year, more than 750,000 Americans suffer from a stroke, which occur either from a lack of blood flow to the brain, known as an ischemic stroke, or from bleeding within the brain, called a hemorrhagic stroke.
Past treatments were limited to clot-busting drugs such as aspirin or, in the immediate aftermath of a stroke, injections of tissue plasminogen activator (TPA). Now, specially trained doctors can provide a new catheter-based treatment or minimally-invasive neurosurgery for medical emergencies within the brain. Advocates say the technological advancement expands realistic hope for recovery beyond the typical three-hour window of TPA intervention.
We asked Alexander Khalessi, MD, director of endovascular neurosurgery at the UC San Diego Health System’s Comprehensive Stroke Center, about the latest developments and about what to do if a stroke appears to be happening.
First and foremost, he said, call 911 immediately. Don’t delay, even if you’re unsure. Prompt arrival at a hospital helps doctors better understand what’s happening, its cause and, if it is a stroke, to help prevent further occurrences.
Q: If I am having a stroke, will I know it?
A: Not necessarily. By attacking the brain, strokes often limit your insight into what is actually happening. Though you may feel normal, you may exhibit symptoms that include garbled speech, weakness or numbness on one side of the body. Worse still, you may be aware of the stroke, but unable to communicate because a particular part of the brain is affected.
Importantly, strokes can occur at night while a person is sleeping. If you or a loved one wake up to symptoms such as prolonged numbness or tingling on one side of the body, do not go back to bed hoping to sleep it off. Seek medical attention.
Also, know your medical record. If you have kidney disease, vascular collagen defects such as Marfan syndrome, a history of smoking or a first relative with an aneurysm, you are at higher risk for stroke. By understanding the signs of stroke – and your own risk – you are in a stronger position to seek timely treatment.
Q: Does a stroke strike instantly or happen over time?
A: Most often, strokes occur in stages. During the first few hours, a stroke may be incomplete. If the blocked artery in the brain is not opened, the entire region of the brain relying upon that artery will continue to die. Using drugs or catheters placed through the leg and up the vast arterial highways to the brain, specialists can locate and eliminate a clot.
Roughly 85 percent of strokes occur from a blocked artery in the brain; the rest involve a bleed or hemorrhage within the brain itself. In a hemorrhagic stroke, seeking specialized care is even more critical. If the bleed is large, neurosurgeons may need to control pressure in the head or remove the clot with surgery while also identifying the source of the bleeding.
For example, cerebral aneurysms – a weakening of an artery of the brain – may burst and cause a hemorrhagic stroke. One-third of these patients will die before reaching the hospital. The other two-thirds will respond to aggressive treatment securing the aneurysm with catheter-based or surgical clipping treatments, combined with neurocritical care. A Comprehensive Stroke Center can provide the full range of necessary treatments for these critically ill patients.
While both forms of stroke can occur over time, immediate treatment has a dramatic impact on the patient’s ability to avoid disability and return to everyday activities. When in doubt, go to the emergency department.
Q: What newer technologies have emerged to treat a stroke?
A: In the last two years, huge strides have been made in the world of devices to treat stroke. At UC San Diego, there are two new FDA-approved devices that the neurosurgical team currently uses to rapidly remove clots, and in some cases, double the chances of saving a patient’s life.
Next-generation stents are also available to repair injuries or plaques in the arteries of the neck to restore blood flow to the brain. Solitaire FR (Covidien) and Trevo (Stryker) have both been proven to open blocked arteries in the brain with greater efficiency and fewer complications. Both of these devices dramatically improve the possibility of a functional outcome in stroke patients with a blockage of one of the major arteries in their brain.
Overall, the catheter-based treatment of stroke, aneurysms, and complex vascular lesions in the brain has taken once impossible problems and placed meaningful recovery within reach.