Effective Treatments For Ischemic Stroke: What You Need To Know

Ischemic stroke, a life-threatening condition, occurs when a blood vessel supplying blood to the brain is blocked by a clot or fatty plaque, causing brain tissue to be damaged or die due to interrupted blood flow. It accounts for about 87% of all strokes and requires urgent treatment to dissolve or remove the clot and restore blood flow. The central goal of therapy is to preserve tissue in the ischemic penumbra by restoring blood flow to the compromised area and optimising collateral flow.

The urgent treatment for ischemic stroke is clot removal, which can be done through medication and mechanical treatments. Medication with drugs such as Alteplase IV r-tPA, a tissue plasminogen activator, can be administered through an IV in the arm to dissolve the clot and improve blood flow. Mechanical thrombectomy, on the other hand, involves using a wire-cage device called a stent retriever to remove the clot.

While ischemic stroke can be treated, those who experience it may still face some degree of disability, including muscle weakness, lack of coordination, difficulty with speech or swallowing, or cognitive symptoms.

What is an ischemic stroke?

An ischemic stroke is a life-threatening condition that occurs when the blood supply to the brain is blocked by a blood clot or a piece of fatty plaque. This interruption of blood flow can cause brain cells to start dying within minutes, which is why rapid diagnosis and treatment are crucial. Ischemic strokes account for about 87% of all strokes.

During an ischemic stroke, a clot or piece of plaque lodges in a blood vessel in the brain, starving brain tissue of oxygen. This can cause a range of symptoms, including drooping muscles on one side of the face, numbness or weakness on one side of the face or in one arm or leg, loss of sensation or abnormal sensations, dizziness, difficulty speaking or understanding speech, and vision problems.

The main cause of ischemic stroke is atherosclerosis, or fatty deposits (plaque) that line the vessel walls. These fatty deposits can cause two types of obstruction: cerebral thrombosis, where a blood clot develops at the site of fatty plaque, and cerebral embolism, where a blood clot forms in another part of the circulatory system and then travels to the brain.

The urgent treatment for ischemic stroke is clot removal, which can be achieved through medication and mechanical treatments. Medication with drugs like alteplase can dissolve the clot and improve blood flow, while mechanical treatments involve using a wire-cage device called a stent retriever to remove the clot.

People who experience an ischemic stroke may recover fully, experience some degree of disability, or die from the event. Those who seek immediate treatment are more likely to have better outcomes.

What causes an ischemic stroke?

An ischemic stroke occurs when the blood supply to the brain is blocked by a blood clot or a piece of fatty plaque. This blockage can occur in several ways.

The main cause of ischemic stroke is atherosclerosis, or fatty deposits (plaque) that line the vessel walls. Fatty deposits can cause two types of obstruction:

• Cerebral thrombosis: a thrombus (blood clot) that develops at the site of fatty plaque within a blood vessel supplying blood to the brain.
• Cerebral embolism: a blood clot that forms in the heart, large arteries of the upper chest or neck, or another location in the circulatory system. A part of the clot may break loose, enter the bloodstream, and travel through the brain's blood vessels until it reaches vessels that are too small to let it pass. A major cause of embolism is an irregular heartbeat called atrial fibrillation, which can cause clots to form in the heart, dislodge, and travel to the brain.

In rare cases, clotting disorders or estrogen-containing oral contraceptives may cause blood clots to form, increasing the risk of clots reaching the brain.

High cholesterol levels, a history of heart surgery, an infection of the heart valves, and a personal or family history of stroke are also risk factors for ischemic stroke. Lifestyle habits such as excessive alcohol intake, a high-calorie diet, and drug use can further increase the risk.

What are the symptoms of an ischemic stroke?

Ischemic stroke is a medical emergency that requires immediate attention. It occurs when a vessel supplying blood to the brain is blocked or obstructed, usually by a blood clot. This blockage prevents blood from reaching the brain, causing brain cells to die within minutes. As such, recognising the symptoms of an ischemic stroke is crucial to ensure timely treatment and reduce the risk of long-term effects.

The signs and symptoms of an ischemic stroke vary but typically include sudden numbness or weakness on one side of the face, arm, or leg. This may be accompanied by a severe headache with no apparent cause and trouble speaking, understanding speech, or seeing. Individuals may also experience sudden dizziness, loss of balance, or coordination issues, making it difficult to walk.

In some cases, individuals may experience additional symptoms specific to women, such as face, arm, or leg pain, and chest pain or palpitations. It is important to note that not all symptoms occur with every stroke, and they may come and go. Some people may experience temporary symptoms, known as transient ischemic attacks (TIAs), which are early warning signs of a potential stroke.

If you or someone you know is exhibiting any of these symptoms, it is crucial to seek immediate medical attention by calling for emergency services. Prompt treatment, such as clot removal through medication or mechanical procedures, can significantly impact the chances of recovery and prevent further damage to the brain.

How is an ischemic stroke treated?

Ischemic stroke is a life-threatening emergency condition that requires urgent treatment. The goal of treatment is to restore blood flow to the brain and prevent permanent damage. Here are the steps involved in treating ischemic stroke:

Emergency Response and Transport:

When someone exhibits signs of stroke, it is crucial to call 911 immediately. Emergency medical services (EMS) play a vital role in providing life-saving treatment on the way to the hospital. Calling for an ambulance instead of driving oneself or relying on someone else ensures quicker diagnosis and treatment, as emergency workers can begin treatment en route and transport the patient to a specialised stroke centre.

Hospital Assessment and Diagnosis:

Upon arrival at the hospital, the patient will be assessed by a dedicated stroke team, including neurologists and neurosurgeons. A neurological exam will be performed to evaluate speech, facial muscles, strength, sensation, coordination, and balance. Brain imaging scans, such as CT or MRI, will be conducted to determine the type of stroke and rule out other conditions. Additionally, blood tests may be performed to check blood sugar levels, as low blood sugar can mimic stroke symptoms.

Thrombolytic Therapy:

If the patient arrives at the hospital within 3 hours (or up to 4.5 hours in some cases) of the first symptoms of an ischemic stroke, they may be eligible for thrombolytic therapy. This involves administering a "clot-busting" drug called tissue plasminogen activator (tPA), such as alteplase, through an IV. This medication breaks up blood clots, improving blood flow to the affected area of the brain. Research shows that earlier administration of tPA leads to better outcomes, reducing long-term effects and improving the chances of recovery.

Mechanical Thrombectomy:

In some cases, a surgical procedure called mechanical thrombectomy may be performed to remove the clot. A catheter is threaded through an artery in the groin up to the blocked artery in the brain, and a stent retriever or special suction tubes are used to remove the clot. This procedure is often done within 6 hours of the onset of acute stroke symptoms but can be extended up to 24 hours in certain cases.

Additional Stroke Treatments:

Beyond the urgent treatment of clot removal, hospital care focuses on various aspects of recovery and prevention:

• Monitoring and observation to detect and prevent complications.
• Identifying the cause of the stroke.
• Initiating treatment to prevent future strokes, which may include medications such as cholesterol-lowering drugs, blood pressure-lowering drugs, antiplatelet therapy, or anticoagulants.
• Starting the rehabilitation process, including determining physical, occupational, and speech therapy needs.
• Providing instruction and guidance for next steps, including a follow-up plan to prevent another stroke.

Lifestyle Changes and Risk Factor Management:

To reduce the risk of recurrent strokes, doctors may recommend lifestyle changes, including consuming less alcohol, following a low-sodium Mediterranean diet, engaging in regular physical activity, and maintaining a healthy weight. Additionally, surgical procedures such as carotid endarterectomy (removal of fatty plaque from the carotid artery) or stenting (insertion of a stent to hold the carotid artery open) may be considered.

What is the outlook for people post-ischemic stroke?

The outlook for people post-ischemic stroke varies. Ischemic stroke is a life-threatening condition that requires immediate medical attention. The earlier a person receives treatment, the better their chances of recovery.

Many people experience some degree of disability after an ischemic stroke, including muscle weakness, lack of coordination, difficulty with speech or swallowing, or cognitive symptoms. These symptoms can improve with aggressive physical, occupational, and speech therapies. The window for meaningful recovery is about six months but can be longer for some patients.

People who have had an ischemic stroke are at high risk of experiencing another stroke in the future. In fact, about a quarter of all strokes occur in people who have previously had one.

It is important for individuals who have experienced an ischemic stroke to work with their healthcare team to prevent further strokes by treating the underlying causes, which may include high blood pressure and atrial fibrillation. Lifestyle changes, such as consuming less alcohol, following a low-sodium Mediterranean diet, getting regular physical activity, and losing weight, can also help reduce the risk of another stroke.

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