Sushrut-Endovascular-Conditions

Stroke Treatment

Intracerebral Hemorrhage(stroke) :

A kind of stroke caused due to bleeding inside the brain tissue is called intracerebral hemorrhage. Usually, stroke occurs when the brain is deprived of oxygen due to an interruption of its blood supply. The main causes for intracerebral hemorrhage are hypertension,arteriovenous malformations or head trauma.

How it occurs?

Due to high blood pressure or hypertension, the walled arteries break and blood spreads into the brain tissue. These blood forms a clot which is known as hematoma. The hematoma grows slowly and causes pressure on the surrounding brain tissue. This pressure makes a person experience tension and lethargic. When the blood spill into the brain, the area that artery supplied will lack oxygen and rich blood. This condition is called stroke. The surface or in deep areas of the brain is the main platform where intracerebral hemorrhage takes place.The symptoms of intracerebral hemorrhage is sudden which requires immediate action. The symptom may alter according to the location of the bleed.

Some of the common symptoms are :

Diagnosis of Intracerebral Hemorrhage :

ICH (intracerebral hemorrhage) requires emergency medical care. When an individual starts showing symptoms of ICH, he or she might be taken for diagnosis. Diagnostic options may include:

Computerised Tomography Angiography
Angiogram and
MRI Scan etc.

Treatments :

Unlike with these ischemic stroke, if you are having a hemorrhagic stroke then treatment goals are to make your blood clot. So, you may be given medication to counteract random blood thinners you take.

You may also be prescribed drugs that can:

• reduce blood pressure
• lower the pressure in your brain
• prevent seizures
• prevent blood vessel constriction

Coiling

During these procedure, specific doctor guides a long tube to the area of hemorrhage or weakened blood vessel. They can install a coil-like device in the area where the artery wall is weak. It blocks blood flow to the area, reducing bleeding.

Clamping

During specific tests, the doctor may discover an aneurysm that has not started bleeding yet or has stopped.

To prevent such additional bleeding, a surgeon may place a tiny clamp at the base of the aneurysm. This cuts off blood supply and prevents a possible broken blood vessel and new bleeding.

Surgery

If any doctor sees that an aneurysm has burst, then a surgery may be done to clip the aneurysm and prevent additional bleeding. Likewise, a craniotomy may be needed to relieve the pressure on the brain after a large stroke.

Hemorrhagic stroke : It occurs due to leaking or bursting of blood vessels in the brain. This results in bleeding in or around the brain. In severe cases, bleeding may cause further swelling of brain tissue. The hemorrhage stroke is of two types:

Subarachnoid hemorrhage (SAH): The bleeding that occurs due to bursting of abnormal or weak blood vessels (aneurysm) between the layers covering the brain around the brain is referred as subarachnoid hemorrhage.
Intracerebral hemorrhage (ICH): The bleeding into the brain due to severe high blood pressure is known as intracerebral hemorrhage.

Treatment of Hemorrhagic stroke :

A hemorrhagic stroke is difficult to treat. The line of treatment specifically depends upon the cause of bleeding. It is an emergency condition that requires close monitoring of the patient in an intensive care unit.

The initial and emergency line of treatment for hemorrhage stroke includes:

Ascertaining the cause of bleeding
Controlling and measuring brain pressure
Control of blood pressure
Discontinuing any other medications

Ventriculostomy tube can be used to measure brain pressure and to drive out blood collected in the brain.

Surgical treatment of Hemorrhagic stroke :

Surgical treatment is often recommended to prevent or stop the bleeding inside the brain. Surgery should be ideally done within first 48 to 72 hours following hemorrhage. But if the patient’s condition is severe then surgery may be delayed for one or two weeks.

The various surgeries done to treat hemorrhagic stroke include:

Aneurysm treatment : The hemorrhagic stroke that has occurred due to bursting of a weak area of an aneurysm (blood vessel) is treated using aneurysm treatment. In this method, a clamp is placed at the base of aneurysm under local anaesthesia. This stops bleeding and prevents re-bleeding. The procedure requires removal of a piece of skull to locate the aneurysm within the brain tissue. The skull piece is replaced at the end of surgery. The procedure may take several hours to complete.
Another less harmful method commonly used is coil embolization. It involves insertion of a catheter into an artery in the groin. The catheter is guided to the vessels in the brain where aneurysm is located. The aneurysm is then filled with a tiny coil. This creates a blood clot within the coil that blocks the blood flow to the aneurysm. Hence, further leaking of blood is prevented.
Arteriovenous malformation treatment : Significant risk of bleeding is associated with arteriovenous malformations (AVMs). Although various techniques like surgery, radiosurgery, or embolization can be done for arteriovenous malformations but the choice depends upon several factors like age of the patient, size and location of AVM and vein abnormalities.
Decompressive craniotomy : Although decompressive craniotomy is the choice of treatment in cases where brain pressure increases due to blood clots but various factors like patient’s age, location and size of hemorrhage, medical conditions, and chances of recovery from stroke are taken into considerations before performing this procedure. It is a life threatening condition that requires opening of skull to remove blood.

Thrombolytic Therapy for Stroke :

The main cause of stroke is blockage of blood supply to the brain due to formation of blood clot. The thrombolytic therapy uses drugs to quickly break the blood clots and dissolve the obstruction to allow blood flow to the brain. This therapy is mainly used for ischemic strokes.

The thrombolytic medications should begin within 3 hours of the first onset of signs and symptoms of stroke. This helps to avoid severe effects of stroke and disability.

Thrombolytic drugs :

Depending on the patients need, the type of drug and treatment procedure is decided. Tissue plasminogen activator (tPA) is the common drug used for this therapy. Other than this, drugs commonly used for thrombolytic therapy are:

Reteplase
Staphylokinase
Lanoteplase
Urokinase

Procedure of administration of Thrombolytic therapy:

Thrombolytic therapy uses a long catheter to inject clot-breaking drugs. Initially, these catheters are inserted into the blood vessels and are later guided towards the blood clot. This helps in giving medications directly to the clot. Radiologic imaging is used to examine if the clot is dissolving or not. A small clot can dissolve within few hours but severe blockage may take several days.

Mechanical Thrombectomy is another method which may be opted. This method utilizes a small suction cup, high-speed fluid jet, rotating device or ultrasound device to physically break the clot.