ACUTE ARTERIAL ISCHEMIC STROKE (AIS) OR BRAIN ATTACK

Q1 What is Acute arterial Ischemic Stroke (AIS)?

AIS means permanent blockage of blood supply to brain causing ischemic symptoms which not recover spontaneously. We need to open the artery soon to prevent permanent deficit.

Q2 What is Transient Ischemic Attack (TIA)?

TIA means temporary blockage of blood supply to brain causing ischemic symptoms which recover spontaneously over few minutes. It is usually precursor of major stroke.

Q3 What are indications for treating AIS?

All acute ischemic strokes should be treated urgently. Time is brain, so earlier we open the artery better are final results.

Q4 How to treat AIS?

AIS can be treated either by IV Thrombolysis or Mechanical Thrombectomy.

Q5 What are advantages of Mechanical Thrombectomy over IV thrombolysis?

  • Limitations of IV thrombolysis are
    1. It can be given upto 4.5hrs only
    2. Only 30-50% patients have good outcome

      Vessel occluded

      % of patients in which revascularization is achieved by
      IV thrombolysis

      ICA

      9%

      M1, BA, VA

      35%

      M2

      54%

      M3

      66%

    3. There are long list of contraindications
  • Advantages of Mechanical Thrombectomy over IV thrombolysis are
    1. More time: It can be done upto 6-24 hrs
    2. It can be done even when IV thrombolysis is contraindicated
    3. Complications and bleeding are less as no rt-PA used
    4. It gives better and instant results (59–88% revascularization)-esp. large arteries. Arteries are opened within minutes compared to rtPA which takes about 2 hrs to dissolve thrombus.

    Q6 What are indications of Mechanical Thrombectomy?

    Indications of Mechanical Thrombectomy are
    1. Patient come within 8-24hrs
    2. ASPECT score of 6 or more on CT scan or MRI
    3. Large artery occlusion
    Patient can be started on IV rt-PA and then shifted to cath lab for mechanical thrombectomy.

    Q7 How mechanical thrombectomy is done?

    There are two methods of mechanical thrombectomy: Stent Retrieval and Aspiration. Both can be used together also.

    STENT RETRIEVAL TECHNIQUE (M1 OCCLUSION)

    Step 1: Femoral artery is punctured and sheath is placed in femoral artery. Then through it guiding catheter is placed into neck vessel.

    Step 2: Then the device (green) is taken through guiding catheter in MCA and thrombus is caught.

    Step 3: Device with thrombus is taken out.

    Step 4: Finally guiding catheter and sheath are removed.

    ASPIRATION TECHNIQUE (BASILAR ARTERY OCCLUSION)

    Step 1: Femoral artery is punctured and sheath is placed in femoral artery. Then through it guiding catheter is placed into neck vessel.

    Step 2: Then the aspiration catheter (green) is taken through guiding catheter in Basilar Artery in thrombus.

    Step 3: Aspiration is started and thrombus is sucked out.

    Step 4: Finally aspiration catheter, guiding catheter and sheath are removed.

    CASE 1: 40yrs male with posterior circulation stroke, Time of Onset: 2hrs. Basilar artery occlusion

    CASE 2: 51yrs female with posterior circulation stroke. Time of Onset: 3.5hrs. Basilar artery occlusion