Experts help to identify and treat stroke, and grasp the golden window period

October 29, 2022 is the 17th “World Stroke Day”, and this year’s theme is “Recognize stroke one second earlier, save the brain and recover well”.

After a stroke, about 1.9 million brain cells die every minute, and brain tissue and its multiple functions, such as movement, language, cognition, and emotion, will also lose synchronously and gradually. If stroke symptoms can be identified early, and patients receive standardized vascular recanalization therapy within 4.5-6 hours of onset, they will have more chances for improvement or even complete recovery. The shorter the time from the onset of stroke to the start of treatment, the better the effect of revascularization therapy. Only by doing early detection, racing against time and seeking medical attention as soon as possible, can we save lives and reduce the occurrence of disability as much as possible.

Green channel shortens stroke DNT time

Stroke DNT time (door to needle time) refers to the time from admission to the start of treatment for acute stroke patients. Both domestic and international guidelines recommend that the DNT time be within 60 minutes, the earlier the better.

At the “Northern Stroke Summit Forum” in 2022, Professor Zhao Shanshan from the Stroke Center of the First Hospital of China Medical University explained the relevant knowledge of “stroke recognition and first aid”. She introduced: In order to unblock the life green channel of stroke patients and shorten the DNT time, the Stroke Center of the First Hospital of Medical University integrates the neurology, neurosurgery, emergency department, imaging department, laboratory, interventional operation room and other departments of the hospital. Resources, the hospital’s “stroke green channel” logo allows patients to find the emergency stroke center as soon as possible; the “stroke priority” logo is set in the charging, drug collection, disposal windows, CT room, MR room and other windows, and stroke patients are given priority inspection and the first Time to issue an inspection report; emergency nurses give priority to drawing blood and medication for stroke patients… and changing the original serial consultation mode to parallel operation. In the process of obtaining the results, the risks and benefits of vascular recanalization therapy are explained. Patients with arrears can borrow medicines for treatment and make up the fees later. With the support of these measures, the DNT of stroke patients has been shortened from an average of 96 minutes in the past to an average of 45 minutes, and the treatment efficiency has been greatly improved.

“BE FAST formula” to identify early stroke

To identify stroke early, it is necessary to master the early identification tool of stroke, which is the “BE FAST formula”. Professor Zhao Chuansheng, Director of the Department of Neurology and Deputy Director of the Stroke Center, The First Affiliated Hospital of China Medical University, said, “The first 5 letters of BE FAST each represent an early symptom of a possible stroke: B – Balance refers to balance , balance or coordination ability. Loss, sudden difficulty walking; E—Eyes means eyes , sudden vision changes, difficulty seeing; F—Face means face , facial asymmetry, crooked corners of the mouth; A—Arms means arms , arms suddenly Weakness or numbness, usually on one side of the body; S—Speech refers to language , slurred speech, inability to understand other people’s language ; T—Time refers to time , reminding that once you find stroke symptoms, do not wait for symptoms to disappear on their own , need to call 120 immediately for medical assistance.”

Grasp the “golden rescue period” for stroke treatment

“Treatment of stroke patients is a race against death. Especially for ischemic stroke, the golden time window for traditional drug intravenous thrombolysis is 4.5 hours, while the golden time window for mechanical thrombectomy is 6 hours. According to the patient’s condition (comprehensive imaging evaluation is required), the time window for thrombectomy can be extended to 24 hours.” Professor Li Zhiqing, deputy director of the Stroke Center of the First Affiliated Hospital of China Medical University, said, “At present, we have very innovative treatments and We have accumulated a lot of clinical experience, and we also hope that more people will improve their awareness of stroke symptoms, detect them as soon as possible, and send them to relevant hospitals as soon as possible, so as to gain the most time and opportunities for life.”

At the “Northern Stroke Summit Forum” in 2022, Professor Li Zhiqing was interviewed by the media on the hot issues of public concern, such as whether stents can be placed in the cerebral blood vessels, and whether the aneurysm should undergo interventional surgery or craniotomy.

Q: What is mechanical thrombectomy? How to perform mechanical thrombectomy?

Professor Li Zhiqing: Mechanical thrombectomy refers to the use of special devices to remove the thrombus blocking large intracranial arteries such as the internal carotid artery, middle cerebral artery and basilar artery, so as to quickly restore vascular patency and protect the function of the nervous system. Intravenous thrombolysis should be considered first for patients with advanced stage, and mechanical thrombectomy may be considered if the time window for intravenous thrombolysis has exceeded. The time window for early mechanical thrombectomy is 6 hours, and a new clinical trial in the United States in 2018 relaxed it to 24 hours, and the treatment depends on the patient’s ischemic collateral circulation and specific impact assessment.

Mechanical thrombectomy is generally performed by puncturing the femoral artery, sending the guiding catheter to the proximal end of the diseased blood vessel, and then sending the microcatheter to the distal end of the thrombus through a micro-guide wire. Pull back slowly to remove the thrombus. At present, balloon guide catheters are commonly used to reduce emboli escape during thrombectomy, and suction catheters can also be used for suction alone, and suction combined with stents for thrombectomy can further improve the efficiency of thrombectomy.

Q: Can stents be placed in cerebral vessels?

Prof. Li Zhiqing: Stents can be placed in cerebral blood vessels. In the early stage of the treatment of wide-necked aneurysms, we used stents as an auxiliary means to prevent coils from protruding into normal cerebral arteries. At present, there are a variety of stents for assisting embolization of aneurysms in clinical practice, and stents with blood flow guidance can be used to treat wide-necked and large aneurysms alone.

In addition, we can also use stents for intracranial arterial stenosis, such as carotid artery, vertebral artery, basilar artery stenosis can be treated with stents, for severe stenosis of extracranial arteries, stents have achieved significantly better therapeutic effects than drugs However, due to the complex anatomical reasons, the advantages of stents in the early treatment of severe intracranial artery stenosis and drug therapy are not obvious. The latest research results show that experienced interventional doctors can treat severe intracranial artery stenosis with positive drug treatment results. With the same clinical efficacy, stenting should be considered in patients with severe cerebral artery stenosis who still have ischemic attacks on drug therapy.

Q: Is intracranial aneurysm better with craniotomy or interventional therapy?

Prof. Li Zhiqing: Craniotomy clipping and endovascular interventional therapy are two treatment methods for the treatment of intracranial aneurysms. For most intracranial aneurysms, both craniotomy clipping and interventional therapy can be performed. A large-scale multi-center prospective randomized controlled study was conducted to compare the safety and efficacy of the two, and it was found that the safety of interventional therapy is much higher than that of craniotomy, especially for posterior circulation aneurysms. Internal embolization has gradually become the main treatment method for cerebral aneurysms. In the early stage, due to the limitation of instruments, the recurrence rate of interventional therapy was slightly higher than that of craniotomy, but this deficiency was acceptable with a high degree of safety. Especially in recent years, with the development and use of new materials and new devices, the long-term efficacy of interventional therapy is also constantly improving, especially the use of blood flow diversion devices is more obvious for large and wide-necked aneurysms. Interventional surgery has good curative effect, small trauma but high cost; craniotomy performed by experienced doctors also has good curative effect, but the trauma is large, the risk is high, and there is scarring of the surgical incision. Discuss with your doctor to choose the treatment that is right for you.

(Editor by Ersanli Ma Jing)