Non-Surgical Procedures Open Blocked Arteries to Prevent and Treat Stroke
Stroke is a "Brain Attack" and a Medical Emergency. Time is brain.
At the first sign of stroke, Call 911
Vascular Experts Treat Blocked Carotid Arteries Without Surgery to Prevent Stroke
A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or bursts, causing the brain to starve. If deprived of oxygen for even a short period of time, the brain nerve cells will start to die. Once the brain cells die from a lack of oxygen, the part of the body that section of the brain controls is affected through paralysis, language, motor skills, or vision.
Stroke Prevalence
- Stroke is third leading cause of death in United States, behind high blood pressure
and cancer
- Every 45 seconds someone in the United States has a stroke
- Every three minutes someone dies from a stroke
There Are Two Types Of Stroke
Ischemic Stroke
Strokes caused by blood clots that block the artery are ischemic (is-KEM-ik) strokes. This is the most common type, accounting for 70-80 percent of all strokes.
Hemorrhagic Stroke
When a blood vessel ruptures, it causes a bleeding or hemorrhagic (hem-o-RAJ-ik) stroke. Once the brain cells die from a lack of oxygen, the part of the body controlled by that section of the brain is affected. Strokes can cause paralysis or language, motor skills or vision difficulties.
There Are Also "Mini-Strokes"
There are also "mini-strokes" known as TIA's (transient ischemic attacks). People who have one TIA are likely to have another one. TIAs cause brief stroke symptoms that go away after a few minutes or hours. People often ignore these symptoms, but they are an early warning sign and 35 percent of those who experience a TIA will have a full blown stroke if left untreated. TIAs should be taken as seriously as stroke.
Stroke Symptoms
The most common symptoms of stroke are:
- Sudden numbness or weakness in the
face, arm and/or leg, especially on one side of the body.
- Sudden confusion, trouble speaking or understanding speech.
- Sudden trouble seeing, including double vision, blurred vision or partial blindness, in
one or both eyes.
- Trouble walking, dizziness, loss of balance or coordination.
- Sudden severe, headache with no known cause.
If you experience any of these symptoms, even if they go away quickly, seek immediate emergency help.
Every minute counts. Although starved of oxygen, brain tissue does not die in the minutes
following a stroke. If blocked blood vessels can be opened within three to six hours, the chances
of recovery are greatly improved.
Risk Factors
- Obesity, high blood pressure and high cholesterol all
increase the risk of stroke. These risk factors can be
greatly reduced with healthy lifestyles or medication.
- High blood pressure puts pressure on the arteries, making
them more susceptible to rupture and more prone to clot
formation, which can block the artery.
- High cholesterol can lead to blockage in the carotid
artery that takes blood from the neck to the brain. A
piece of this plaque can break off and travel to the
brain, causing a stroke.
- Obesity can cause high blood pressure and high
cholesterol.
- Untreated atrial fibrillation causes the heart’s
upper chamber to beat irregularly, which allows the blood
pool and clot. If a clot breaks off and enters the blood
stream to the brain, a stroke will occur.
- Sickle cell anemia makes red blood cells less able to
carry blood to the body’s tissues and organs, as
well as stick to the walls of the blood vessels. These
cells can block arteries to the brain, causing a stroke.
- Family history
- Smoking
Prevention and Carotid Stenting
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As vascular experts, interventional radiologists treat atherosclerosis, "hardening of the
arteries," throughout the body. In some patients, atherosclerosis, specifically in the
carotid artery in the neck, can lead to ischemic stroke. Plaque in the carotid artery may
result in a stroke by either decreasing blood flow to the brain or by breaking loose and
floating into a smaller vessel, depriving a portion of the brain of blood flow. In patients at
high risk of having a stroke, the narrowed section of artery may be reopened by an
interventional radiologist through angioplasty and reinforced with a stent, thereby
preventing the stroke from occurring. Vascular stents are typically made of woven, laser-
cut or welded metal that permits the device to be compressed onto a catheter and
delivered directly into the hardened artery. In addition to diagnosing and treating those at
risk for stroke, interventional radiologists use their expertise in imaging, angioplasty and
stenting to treat those having an acute stroke.
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The carotid arteries on
either side of the neck supply blood to the brain |
Patients can also take action to prevent strokes by:
- Stop smoking
- Controlling high blood pressure
- Lowering cholesterol levels
- Maintaining healthy weight
- Exercising
- Utilizing appropriate medications like aspirin,
prescription drugs like anticoagulants
- Treating carotid artery disease
- Treating unruptured cerebral aneurysm or arteriovenous
malformation
Assessing Patients at Risk for Carotid Artery Disease and Future Stroke
Physical examination. Your doctor
may be able to assess your risk for stroke during a routine
physical examination. If your physician suspects that you may be
at high risk, he or she will ask if you have experienced symptoms
such as numbness or muscle weakness, speech or vision
difficulties, or lightheadedness. By listening to the carotid
artery through a stethoscope, the doctor may hear a rushing
sound, called a bruit ("brew-ee") that suggests the
artery may be obstructed. Physical exam is not always accurate,
however, and further tests may be ordered.
Ultrasound. A technique
called doppler ultrasound that creates pictures using
sound waves can determine whether there is blockage in
the arteries that carry blood to the brain. Some
physicians recommend ultrasound screening for those who
have been diagnosed with atherosclerosis or other risk
factors for carotid artery disease. In the ultrasound
image shown here, normal blood flow is in red. Blue areas
show where flow is obstructed by a blockage in the
carotid artery. |
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Magnetic Resonance Angiography (MRA).
This is a non-invasive diagnostic technique that creates an image
of the arteries in the brain. A magnetic resonance (MR) scanner
uses harmless but powerful magnetic fields and radio waves to
create detailed images of the body's tissues.
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Diagnosis
There are a number of diagnostic exams that can be performed to determine if someone has had a stroke or is at risk for having one.
When a stroke is suspected:
A CT scan. The area affected by stroke is purple.
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Computed tomography (CT). The first diagnostic test performed in the emergency room is usually a CT scan. CT uses computers to generate detailed pictures of the brain, and can confirm the diagnosis of stroke and tell whether the stroke is caused by a hemorrhage in the brain.
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Patient having an angiogram
Magnetic Resonance Imaging
(MRI) is a diagnostic test which may be performed to
identify and further localize the site of the stroke and
find the source. It may be able to quickly identify the
area deprived of sufficient blood flow and guide further
therapy. In the MR Image, the arrow points to the area
affected by a stroke. |
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Angiography. An angiogram
is an X-ray in which a contrast agent, or dye, is
injected into a vein to highlight the blood vessels. With
this exam, radiologists can pinpoint the exact location
of blockage or bleeding in the brain. Angiography also is
used to guide thin tubes called catheters to the site of
the problem and administer treatments. |
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Treatment
Interventional radiologists are a critical part of the stroke team in hospitals and are actively involved
in creating more stroke teams across the country. Stroke teams generally consist of emergency room physicians,
neurologists, and interventional radiologists.
For those having a stroke, it must first be determined which kind of a stroke the patient is having so the
proper treatment can be given. The interventional radiologist interprets the non-contrast CT (computed tomography)
imaging to determine if acute stroke patients are candidates for clot-busting drugs. CT is quick, inexpensive,
and readily available.
If the stroke is determined to be ischemic (due to a blood clot), the interventional radiologist will
assess what caused the clot, such as a clogged carotid or other artery, and can correct the underlying problem to
prevent future strokes from occurring.
Treatment to Dissolve Blood Clots
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If the stroke is due to a blood clot, a clot-busting drug, tPA (tissue plasminogen activator)
can be given intravenously to break up or reduce the size of blood clots to the brain.
This technique must be performed within three hours from the onset of symptoms.
When therapy cannot be initiated within three hours or when treatment with tPA during the
first three hours is not sufficient to dissolve the blood clot, interventional radiologists (IR) that
specialize in neurological procedures can provide intra-arterial thrombolysis treatment.
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Using x-ray guidance, an IR will insert a catheter through a nick in the skin at the groin and advance
it through the femoral artery in the leg all they way to the tiny arteries in the brain where they place
the clot-busting drug directly on the clot or to break up the clot mechanically.
When given locally this way, the tPA can be administered up to six hours
after the onset of stroke symptoms. In many cases, the ambulance drivers will take a stroke victim past
the three-hour window directly to the interventional radiology suite for assessment for this direct
thrombolytic therapy. Often a significantly disabled stroke patient who receives this treatment can
return to normal life with minimal or no after effects from the stroke.
The interventional radiologist will also assess what caused the clot, such as a clogged
carotid or other artery, and can correct the underlying problem to prevent future strokes
from occurring. Unfortunately, many hospitals in this country do not have stroke teams
that can rapidly assess patients and provide treatment within the three-hour window.
Interventional radiologists are actively involved in creating more stroke teams across the
country. Stroke teams generally consist of emergency room physicians, neurologists and
interventional radiologists.
 Before tPa therapy |
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 After tPa therapy |
Treatment for Hemorrhagic Stroke
Interventional neuroradiologists can also treat ruptured
aneurysms inside the brain causing hemorrhage into the
subarachnoid space, which can cause stroke or death. During the
embolization technique, an interventional neuroradiologists
inserts a catheter through a nick in the skin of the groin and
advances it to the site of the ruptured blood vessel. An
embolizing agent (a substance that clots or closes off the
bleeding blood vessel) is injected under X-ray guidance. Most
commonly, tiny metal coils are used to embolize and block the
abnormal blood vessel or aneurysm. The catheter is withdrawn and
the coils remain to provide the occlusion. The same technique can
be used to treat aneurysms and AVMs before they rupture. Surgery
had been the primary treatment available until the platinum coil
device was approved by the FDA in 1995.
Stroke Facts and Statistics
- Nearly half of all stroke fatalities occur before
emergency medical personnel arrive.
- 1.1 million Americans live with disabilities caused by a
stroke.
- 600,000 Americans will have a new or recurrent stroke
each year—of these, 160,000 will die.
- Stroke is a medical emergency with a narrow time frame
for treatment—people should call 911 immediately.
- Strokes can be treated intravenously with the
clot-busting drug, tPA (tissue plasminogen activator), if
it is given within three hours of the onset of symptoms.
- Persons who have a transient ischemic attack (TIA), also
known as a mini-stroke, are likely to have another one.
Transient ischemic attacks cause brief stroke symptoms
that go away. People often ignore these symptoms, but
they are an early warning sign and 35 percent of those
who experience a TIA will have a full-blown stroke if
left untreated.
- Stroke is not just an older person’s disease—28
percent of strokes occur in people under age of 65.
- More men than women have strokes—although more women
die from them.
- African Americans are at much higher risk for stroke. In
part, this is because African Americans are at increased
risk for obesity, high blood pressure and diabetes, which
increase the risk of stroke.
- May is Stroke Awareness Month.
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