Treatment of ischaemic strokes

What is an ischaemic stroke?

An ischaemic stroke (apoplexy, cerebral stroke) is a sudden blood flow impairment in the brain. In most cases, this acute reduction in the blood flow (ischaemia) is caused by an occlusion of large cerebral arteries by a blood clot (thrombus), which is washed from the heart or the carotid arteries with the blood into the brain. Less often, an intracranial stenosis can be the cause of an ischaemic stroke (patient information: Treatment of Intracranial Stenosis).
A reduction in blood flow of this kind leads to a lack of oxygen in the affected area of the brain. As a consequence, the function of the nerves in this area of the brain is restricted. Longer lasting occlusions can cause irreversible damage to the brain cells and result in a cerebral infarction. Immediate medical treatment is therefore urgently required.

What are the consequences and dangers?
As a consequence of the acute blood flow impairment, the brain cells do not receive sufficient oxygen and nutrients, causing them to die off. This can lead to deficiencies in brain function. These can be expressed in the form of sudden painless paralysis of one side of the body, sensations of numbness, and balance, speech or sight impairments. Stroke victims are often unable to communicate. In this event, an emergency doctor must be called immediately so that the patient can be taken as quickly as possible to the nearest hospital specialised in stroke treatment. If the blood flow impairment is treated swiftly, the deficit manifestations can be partially or fully regressed; in other cases, they remain permanently. In severe cases, an ischaemic stroke can lead to coma or even death.
What are the risk factors?
The risk factors for an ischaemic stroke include unhealthy habits, but circumstances that are almost or entirely beyond the control of the individual also play a part. A lifestyle characterised by a high-calorie and high-fat diet, smoking, lack of exercise and stress increases the risk, as do high blood pressure, overweight, diabetes, atrial fibrillation or coagulation dysfunction. Other factors are age and a genetic or familial predisposition.
What are the treatment options?

In the event of a stroke, it is of decisive importance to restore the brain’s blood flow as quickly as possible. The standard treatment involves the administration of a drug, which dissolves the blood clot and should reopen the vessel occlusion.
However, drug treatment is often insufficient in particularly severe cases. In these cases, the vessel can be reopened using a minimally invasive procedure. A microcatheter (thin plastic tube) is inserted, running from the groin to the vessel occlusion in the head. From this position, the thrombus is extracted from the brain with stent-like systems or catheters, thus restoring the brain’s blood flow immediately. This technique has improved considerably in recent years, with the result that the blood clot, in nearly all cases, can be removed quickly and completely from the cerebral vessel.

Summary

Ischaemic stroke is a high-risk disease to be taken seriously. In the event of a stroke, the quickest possible acute treatment in a specialist stroke unit is required. Every stroke is an emergency – every minute counts!
The treatment method deployed depends on various factors, such as the time elapsed since the stroke occurred and the location of the vessel occlusion, and is determined by the treating doctor.
The earlier the treatment, the higher the chances of the patient making a full recovery without any remaining permanent damage or limitations.