Stroke is the leading cause of serious, long-term disability with approximately 500,000 cases of stroke each year. It accounts for about 160,000 deaths, and in stroke survivors, there is a 25-29% recurrence rate over 5 years (4-14% annual rate). The goal of treatment of these patients is to diagnose the problem as quickly as possible and triage them to the appropriate therapy. The Interventional Neuroradiology/Endovascular Neurosurgery service participates in a multidisciplinary effort to prevent and treat acute stroke.
Along with the NEUROLOGISTS we evaluate patients in the emergency room according to physical exam using the NIH stroke scale and clinical history. Non-contrast head CT is performed followed by a CT angiogram (CTA). This takes just a few minutes to review and gives us information about the nature of the stroke. We look for evidence of hemorrhage or edema from brain swelling. 80% of strokes are ischemic and 20% are hemorrhagic. The CTA defines the location and cause of the blockage in the artery from the aortic arch up through the brain.
For patients reaching the hospital within three hours of onset of symptoms, IV tissue plasminogen activator (tPA) is the FDA approved treatment. In addition, these patients may receive intra-arterial therapy with a catheter system placed in the artery, which is blocked. This is done under general anesthesia and usually takes a few hours. Patients reaching the hospital within 3-6 hours are treated with only the catheter system using tPA or urokinase. This is administered with a catheter placed directly into the blockage. Patients reaching the hospital between 6-8 hours following a stroke may be offered endovascular treatment with a clot removal device such as the Concentric or the clot retrieval wire. These procedures are performed under general anesthesia. Patients are then followed in the Neuro-intensive care unit.