Treatment for stroke
Treatment for stroke
Remember: A stroke is a medical emergency, not a “curse” or a simple weakness. Reaching a hospital as early as possible can make the difference between a full recovery and permanent paralysis.
Stroke is of two types, ischemic stroke and haemorrhagic stroke.
Treatment for ischemic stroke:
Endovascular therapy (EVT) for ischemic stroke or mechanical thrombectomy, is a minimally invasive, highly effective treatment for acute ischemic stroke caused by large vessel occlusions (LVO). It involves navigating catheters through blood vessels to remove blood clots using specialized devices.
Window period for medical management for thrombolysis lasts upto 4.5 hours of stroke onset, while endovascular interventions for stroke can be perform upto 24 hours of symptoms onset, but ideally it should be done as early as possible. With over millions of neurons loosing per minute, time is crucial . Endovascular treatment for stroke offers significantly improved functional outcomes, lower mortality, and faster recovery compared to medical management alone, even in cases with large ischemic cores.
Key Aspects of Endovascular Therapy for Stroke:
Procedure Details: Performed by neurointerventionalists/neurosurgeon , Dr Saurabh Kumar Sinha
A catheter is inserted usually through the groin and guided to the blocked brain artery using X-ray imaging.
Techniques: Mechanical Thrombectomy: Uses stent retrievers (stent-based) or aspiration catheters (suction-based) to remove the clot and restore normal blood flow towards brain tissue.
Intra-arterial Thrombolysis: Delivers clot-dissolving drugs directly to the blockage.
Angioplasty/Stenting: Used if the vessel is too narrow or for tandem occlusions stent is placed in brain blood vessels to prevent restenosis.
Sometime, patient may require even more perfusion, then bypass brain surgery and/or carotid endartectomy can also be done to enhance blood flow and prevent stroke.
Treatment for haemorrhagic stroke:
When a blood vessel bursts in the brain (a Hemorrhagic Stroke), it creates a collection of blood called a hematoma. This blood puts dangerous pressure on the brain. In the past, treating this was a major, frightening ordeal. Today, thanks to advanced technology, the approach has changed completely.
Small Bleeds: The “Watch and Wait” Approach
Scans: CT or MRI to see the size of hematoma, brain edema, hydrocephalus etc.
Eye Checks: Measuring the pupillary size, response and “Optic Nerve sheath diameter ” (the nerve behind the eye) can tell us if the brain is under normal or high pressure.
Direct Monitoring: Sometimes, a tiny sensor is used to track pressure exactly.
Large Bleeds: The Old Way vs. The New Way
If the bleed is large, the blood must be removed to save the patient’s life and brain function.
The Old Way (Decompressive Craniectomy)
In the “old days,” surgeons had to remove a large piece of the skull bone to reach the brain.
The Downside: It was a massive surgery with high morbidity.
The Second Surgery: The patient would have to live without a piece of their skull for weeks or months, then undergo a second major operation later to put the bone back.
The New Way (Keyhole Endoscopic Surgery)
We now use Neuro-Navigation (essentially GPS for the brain) to perform “Keyhole” surgery.
How it works: Instead of a large opening, the surgeon makes a tiny hole. Using a thin tube with a camera (an endoscope), they navigate directly to the blood and clear it out.
Why it’s better:
Tiny Incision: Less scarring and much less pain.
Faster Recovery: Patients often get back on their feet much sooner.
One and Done: Because we don’t remove a large section of the skull, there is no need for a second surgery months later to “put the bone back.”
Brain surgery isn’t what it used to be. With Minimally Invasive Surgery, we can now treat even large strokes with more precision and less trauma to the body. If a loved one is facing this, ask your specialist about “Keyhole Endoscopic Evacuation.” It is safer, faster, and much easier on the patient.
Off course the final decision regarding need of surgery and type of surgery depends on a number of factors includes patient clinical condition, size of hematoma, location of hematoma, brain edema, presence or absence of hydrocephalus, midline shift, etc and your neurosurgeon is best judge to take appropriate decision for patient.