Stroke is perhaps one of the most catastrophic events that may happen in everyone’s life. Only in Germany, around 270,000 people suffer a stroke every year. About 20 percent of which die just within four weeks. Many of those who survive a stroke remain permanently disabled. Therefore, a prompt and high-quality treatment is required. 

Like a heart attack, stroke is a life-threatening emergency that needs to be treated as quickly as possible. A stroke usually occurs when a blood vessel in the brain is blocked by a clot. The surrounding brain area eventually dies because it is no longer supplied with blood and oxygen. Depending on which part of the brain is affected, stroke manifests itself with different symptoms. A sudden deafness or paralysis on one side of the body, such as a dangling corner of the mouth or arm, visual disturbances such as double vision, loss of visual field or short-term blindness often may occur. Speech problems such as slurred speech, sudden dizziness, and strong, unusual headaches are also common warning signs, which must be taken into account. In these circumstances, an ambulance must be called immediately.

With a novel procedure in which the clogged blood vessel in the brain is reopened with a catheter system, even severe strokes can be successfully treated. The new therapy is now also available at the Esslingen Hospital.

The longer the affected brain area is not supplied with oxygen due to a blood clot, the more brain cells go under, the more serious the effects. "Without a treatment, every minute around 1.9 million neurons die in the brain during a stroke due to poor circulation," says Dr. Matthias Reinhard, the Chief Physician of the Department of Neurology and Clinical Neurophysiology at the Esslingen Hospital. As doctors like to say "Time is Brain", so the measurements should be taken promptly.

A nationwide network of so-called stroke units is aimed to provide a quick and continent treatment for patients suffering from a stroke. The Department of Neurology at the Esslingen Hospital also has such a modern treatment center with ten different areas, in which around 1,100 patients are admitted every year with a suspected stroke. "Around 900 of these patients have early signs of a stroke, a so-called transient ischemic attack (TIA), i.e. a circulatory disorder of the brain," says Professor Reinhard.

A vascular imaging with contrast agent in the computed tomography (CT) shows the doctors the closed blood vessel in the brain and confirms the suspicion of a stroke. In most cases, a lysis therapy is then the most important treatment option. A special drug is added to the bloodstream via a drip, with the help of which the blood clot can be dissolved and the clogged vessel can become free again. "We optimized our procedures so that we usually start lysing within 30 minutes after the patient has been admitted to our Stroke unit," says Professor Reinhard. Previously, the suspicion of a stroke had been confirmed by the image from CT scan. For vascular occlusions up to one centimeter in length, the lysis therapy is very successful. The clot becomes dissolved after some period of time. It’s important to initiate the treatment as soon as possible because the time window for the lysis is quite short. The therapy can be very effective only if the lysis is started four hours after the stroke. In rare cases, the time window can be extended to six hours or more.

Less serious disabilities after the stroke
Therapy is especially challengeable in relatively larger vascular occlusions, especially in the large cerebral vessels. "With a new catheter procedure, the so-called mechanical thrombectomy, used in addition to the lysis, the chances of coping with such a large stroke without serious disabilities could be doubled," reports Professor Reinhard. In this new thrombectomy technique, a catheter system is advanced from the groin under X-ray control to the vascular occlusion in the brain. The clot is then pierced with a wire and a microcatheter inserted over it. A stent connected to the catheter is placed over the microcatheter and deployed. The clot is caught in the mesh of the stent and can be easily pulled out. The blood vessel is opened and the supply of the threatened brain area restored with oxygen.

The procedure is relatively gentle for the patients, but also quite complicated and requires a lot of experience. Therefore, the Esslingen Hospital cooperates with the Stuttgart Katharinenhospital. This cooperation has been shown to be very effective and successful in the treatment of difficult and rare cases of stroke. 

A system of catheters remove the clot
From the site of access in the groin to vascular occlusion in the brain, three to four catheter systems are required. "You have to imagine this as in horsetail technology," explains Professor Krämer. From the sluice in the groin, a catheter with a larger diameter is advanced into the main artery. A second, thinner catheter is then passed through the first to the head. Finally, a microcatheter with the tool at the tip is advanced to the clot that is trapped there with the stent. That's a quite long way. "Accessing the catheter via the groin has been proven in many other vascular interventions. In addition, the access site can be closed again after the procedure without greater risk of bleeding."

Dr. Reinhard, the head of the Esslingen's Stroke Unit, estimates that about ten percent of stroke patients could benefit from thrombectomy treatment.

Are you interested in learning more about the treatment methods discussed in this article? Contact us today to speak with a Medscout Healthcare Consultant. Medscout team will support you throughout the entire treatment course.