Treatment of stroke Flashcards
What is Thrombolysis?
It is a treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs.
-Thrombolysis may involve the injection of clot-busting drugs through an intravenous (IV) line or through a long catheter that delivers drugs directly to the site of the blockage.
It also may involve the use of a long catheter with a mechanical device attached to the tip that either removes the clot or physically breaks it up.
What is the aim of thrombolysis?
TO restore perfusion before cell death occurs
How fast are neurons lost when a stroke is untreated?
The typical patient loses 1.9 million neurons each minute in which stroke is untreated
How does the benefit from thrombolysis decline?
It declines with increasing delay from onset
What are significant intracerebral heamorrhage predictors?
- Age
- Glucose
- Stroke severity
- Hyperdense cerebral artery on CT scan
- ASPECTS score
- Anti-platelet therapy
Features of alteplase in the treatment of ischaemic stroke
- Benefit of using alteplase outweighs the risk when used up to 4.5 hours after the onset of symptoms.
- The benefit of alteplase in the treatment of stroke is highly time-dependent and therefore minimising the time to the start of treatment is critical to ensuring the best possible outcome.
What are the practicalities of FAST treatment?
- Stroke symptom recognition
- Calling for help
- Alerting hospital team
- Alerting CT/radiology team
- Keeping the patient/relatives informed
How is Thrombectomy performed?
A system of coaxial catheters is pushed inside the arterial circulation, usually through a percutaneous access to the right femoral artery.
- A microcatheter is finally positioned beyond the occluded segment and a stent-retriever is deployed to catch the thrombus; finally, the stent is pulled out from the artery, usually under continuous aspiration in the larger catheters.
Why are stroke units important?
- Mobilise ASAP
- Concentrate on simple things like swallowing, positioning etc.
- Early therapy
- Concentrating of expertise!!
- Swallow problems are present in 50% of stroke patients
Contraindications to thrombolysis
- Age
License currently limited to <80 years - Prior intracranial haemorrhage (ICH)
- For MI: recent bleeding, very high blood pressure etc
What is craniectomy?
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed.
- To decrease pressure.
When should a hemicraniectomy be performed?
For individuals aged up to 60 years who suffer an acute MCA territory ischaemic stroke complicated by massive cerebral oedema, surgical decompression by hemicraniectomy should be offered within 48 hours of stroke onset.
Features of Transient ischaemic atack (TIA)?
- Aetiology no different from definite stroke
- A TIA is a “warning/mini stroke” with stroke-like symptoms persisting less than 24 hours.
- Prompt evaluation is needed
- TIA and stroke have the identical risk for early recurrent stroke – up to 14% within the first 2 weeks.
How can the risk of a recurrent stroke be reduced?
- Early treatment of TIA or minor stroke
- Early initiation of preventative treatment can reduce the risk of early recurrent stroke by 80%.
- TIAs and minor strokes should be considered as medical emergencies
Secondary prevention methods of stroke
- Clopidogrel 75mg OR Aspirin 75mg plus dipyramidamole MR 200mg bd
- Statin
- Blood pressure drugs, even if blood pressure in normal range e.g. Diuretics, calcium channel blockers, beta-blockers, ACE inhibitors, angiotensin II receptor blockers, alpha blockers.
