Dr Gurucharan S Shetty, Interventional Radiologist, Fortis Hospital highlights the role of interventional radiology in managing stroke
Every year, approximately 1.8 million people suffer from a stroke, one of the leading causes of death and a major cause for disability and morbidity, making the victim depend on others for his daily activities and livelihood.
When the blood supply to a part of your brain is interrupted or reduced, brain tissue is deprived of oxygen and nutrients, resulting in the death of brain cells called a stroke. Strokes are of two types. One variety is the ischemic stroke where a blockage or a blood clot cuts off the blood supply to an area of the brain and the other is the hemorrhagic stroke where bleeding from an artery cuts off the blood supply to an area of the brain. So, with the larger the vessel involved, more significant portion of the brain would be affected leading to a poorer outcome.
The term “interventional radiology” refers to using catheters, balloons, stents, and coils under imaging guidance and with pinhole access through blood vessels rather than open surgery to treat patients. Interventional radiology is one of the latest advancements in therapeutics where imaging guidance and small catheters, balloons, stents, etc., are used to treat complex vascular problems, cancers, and various other ailments, including the dreaded acute brain stroke.
What is the endovascular treatment of stroke?
For a long time, the treatment involved just giving clot-busting drugs through the veins. While this was effective in clearing small clots, it was ineffective in removing larger clots in the brain arteries. Later with the advent of neurointerventional hardware, small catheters were initially used to deliver these same medicines to the target area of the clot.
The tipping point came when small metal constructs called stents were used to engage these clots and pull them out, This was later augmented by using negative suction or aspiration techniques in tandem to pull out sticky resistant clots and using methods to prevent the clot from migrating as it was pulled out. A slew of multiple clinical trials in 2015 in different parts of the world all concluded that this was indeed the most effective and efficient treatment for acute ischemic stroke and led to it’s worldwide acceptance as the gold standard treatment for the treatment of acute ischemic stroke, especially those with clots in the larger vessels of the brain.
Things to know about the treatment
First, the stroke must be detected. One has to recognize that an artery is blocked, and a large brain area is at risk. If it has already been too late, removing the clot may not help if the brain is already damaged.
–The blood clot can be removed by encasing it in a stent and pulling it out with it or sucking it out through the catheter.
-The stent retrievers are extremely effective at removing clots. In addition to clot extraction, first-pass aspiration techniques are widely used.
-In case of a persistent narrowing or diseased narrowed artery further treatment with angioplasty may be needed
Endovascular therapy has been shown to improve outcomes and reduce long-term disability following an ischemic stroke, with CT or MRIs determining a patient’s eligibility to receive it. Due to advancements in imaging technology, the time window for these procedures has widened.
What is a Bi-plane Cathlab and how does it help in managing strokes?
Biplane Cathlab creates high-resolution three-dimensional images of the brain’s complex blood vessels, simultaneously from two distinct angles, recording many frames per second, with the help of a contrast dye injected into the patient’s circulatory system.
The physician threads a catheter from the patient’s groin through blood vessels in the abdomen, chest, and neck to the precise location of the problem in the brain or spine while watching the screen. It helps lasso blood clots, prevent an aneurysm burst, place permanent scaffoldings, or cut off a tumor’s blood supply using microscopic tools and functions as a GPS in interventional procedures, providing a road map to the desired location in the brain.
A few benefits:
- Cutting-edge technology aids in the creation of highly detailed images of blood vessels and tissues and early detection of damage.
- Short and minimally invasive procedures, eliminating the need for open surgeries.
- 70% less effective radiation and faster recovery.
- Due to 3D imaging, visualization from two planes at the same time is possible
- Reduces quantity of contrast used to visualize vessels and hence can prevent renal complications.
Despite the high costs of these technologies, sophisticated healthcare facilities in the private sector have been fast to find and incorporate advanced treatments into their hospital systems. The fact that such modern technology and therapies are available in our cities and towns and hospitals demonstrates that the world’s most advanced treatments are also available in our neighborhood. It reaffirms our healthcare providers’ dedication to providing the finest possible care to their patients.
Systemic efficiency remains the essential element in treatment outcomes. The patient attendants must instantly recognise a stroke and transport the patient to a center that offers mechanical thrombectomy. When done correctly and within the time frame, this procedure can miraculously reverse a stroke.
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