Availability of minimally invasive procedures that can close the PFO and LAA are therapies that are increasingly being used for stroke prevention

Dr Mohan Nair, Coordinator and head cardiac science, Holy family hospital highlights the latest advancements that have enabled better management of stroke

Since the start of the COVID pandemic, has there been an increase in the number of stroke cases in India?

Unlike some countries like Italy and Spain, India does not have any specific data related to Stroke incidence in COVID. I can only say that stroke has been an important thrombotic complication seen during COVID. It is also documented that patients with atrial fibrillation, which is a recognised risk factor for stroke have had worse outcome during COVID.

What are the latest advancements that have enabled better management of stroke?

When blood flow is obstructed through either a blocked vessel in the brain (ischemic stroke) or a burst of the blood vessel in the brain (haemorrhagic stroke), a stroke occurs.  Blood clots that form in the heart due to conditions like Atrial Fibrillation (AF) and birth defects like Patent Foramen Ovale (PFO) form an important source of ischemic stroke.

AF is a condition that involves irregular beating of the atrium (upper chamber) of the heart, increases a person’s risk for stroke by up to six times as compared with the people who do not suffer from it. When suffering from this condition, blood clots are most commonly formed in a part of the heart called Left Atrial Appendage (LAA). If a blood clot forms, it could dislodge from the heart and travel to the brain where it might block blood flow, causing a stroke.

The mainstay of stroke prevention in atrial fibrillation is the use of blood thinning drugs. Over the past decade, several new oral blood thinning drugs have become available (NOACS), that are safer and more easy to use; hence more patients with atrial fibrillation can now be protected from the dreaded complication of having a stroke.

Some people, however, are not candidates for the use of drugs, and for these people, new technology, has come as a boon. Closing the LAA is an important way of reducing stroke risk in people with AF.  A device called LAA occluder is implanted inside the heart to permanently close the LAA to keep the blood clots forming, despite on-going atrial fibrillation. This can now be done with a minimally invasive catheter procedure. The procedure involves making a small incision in the leg and inserting a small catheter to guide the device to the LAA through the blood vessels to the heart. This seals off the LAA and keeps it from releasing clots. A similar procedure is can also be used to close PFO.

What measures can help in reducing the incidence of stroke?

Recognition of risk factors and addressing them promptly plays a key role in prevention of both stroke and also atrial fibrillation. Important risk factors include high blood pressure, diabetes etc; Lifestyle could also play plays a vital role in preventing the rising incidence of Stroke in India. Regular exercise, maintenance of ideal weight and some diet modifications have been shown to have an important impact.

Availability of minimally invasive procedures that can close the PFO and LAA are therapies that are increasingly being used for stroke prevention in patients at risk.

What is your message on World Stroke Day?

As is evident from the above discussion, there is a great opportunity today for prevention of stroke; and this begins with awareness about risk factors and some simple measures such as lifestyle modification and proper management of hypertension, diabetes etc. Technical advances like LAA Occluder are also proving to play an important role in stroke prevention.