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Time is a crucial factor in the first few hours of a stroke (acute phase) as an average of 2 million neurons die every minute. Treatments aimed at recovering blood flow should be used up to 24 hours after the stroke.
Intravenous thrombolysis. A medicine which dissolves blood clots is injected into a vein.
Mechanical thrombectomy. A technique used when the blood clot has blocked one of the major arteries carrying blood to the brain. A catheter is introduced into an artery in the groin until it reaches and unblocks the obstructed cerebral artery.
Until recently the only effective treatment in the acute phase of stroke was administration of a thrombolytic agent to try and dissolve the blood clot and save some of the brain tissue susceptible to death. This treatment must be administered in the first 4.5 hours after a stroke and only to patients for whom the technique is not contraindicated (the main contraindication is any situation that increases the possibility of haemorrhage as it represents the foremost complication of thrombolytic treatment).
Five large studies have been published worldwide in the last 12 months. One of them was the REVASCAT study in Catalonia that demonstrated the effectiveness of mechanical thrombectomy in patients who suffered a severe stroke due to obstruction of one of the brain’s main arteries. A catheter is introduced in an artery in the groin and used to transport a stent, a small mesh tube, to the blocked artery in order to trap the blood clot in the stent’s mesh and subsequently remove it from the circulatory system.
This procedure must be performed in hospitals with experience treating severe strokes and at the earliest possible opportunity as the treatment’s efficacy diminishes rapidly over time; nevertheless, some patients may benefit from the procedure up to 24 hours after a stroke.
Once the patient has been admitted, and while tests are being carried out to discover the cause, general treatment includes different strategies: prevent another stroke in the following days; control blood pressure and blood glucose levels; maintain adequate blood oxygenation; provide fluids and nutrition; and prevent and treat any stroke-associated complications.
Antiplatelet agents, which limit platelet activity (the blood cells that initiate the coagulation process), or anticoagulants, which interrupt some of the later steps in the coagulation cascade system are prescribed to prevent recurrent strokes.
Blood pressure is managed with either intravenously or orally administered medicines, according to the patient’s blood pressure at any given moment. The ideal blood pressure range varies in function of the extent of the stroke and whether the artery causing the problem remains blocked or has been unobstructed.
High blood sugar levels are associated with a poor recovery from a stroke. For this reason, efforts are made to maintain normal values and avoid low sugar levels, which are also harmful. To control blood sugar, medicines such as insulin sometimes have to be used during hospitalisation, even in patients who have never used it before suffering a stroke.
The most common complications associated with stroke are infections, either respiratory or urinary. Infections must be treated with the appropriate antibiotics as soon as they are diagnosed.
Some cases of haemorrhagic stroke in which bleeding is close to the surface can undergo surgery to remove the blood or treat the bleeding lesion, as in the case vascular malformations. The patient may also require an angiography to repair the damaged blood vessel.For example, if the hemorrhage is secondary to an aneurysm, this can be covered by placing wires (coils) or by placing clips (clips) by surgery. These interventions leave the injured vessel wall out of circulation, which prevents it from bleeding again.
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Substantiated information by:
Antonia FernándezNurseNeurology Department
Arturo Renú JornetNeurologistNeurology Department
Xabier Urra NuinNeurologistNeurology Department
Ángel Chamorro SanchezHead of the Cerebral Vascular Pathology Unit
Published: 20 February 2018
Updated: 8 August 2018
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