Stroke is a disease with high morbidity, mortality, disability and recurrence rates. The recently published “China Stroke Prevention and Control Report (2015)” shows that stroke is the first cause of death in China and the prevalence is on the rise, with about 30% of those who develop the disease dying and those who survive may also have disabilities such as hemiplegia and aphasia. Currently, there are more than 7 million people with cerebrovascular disease in China, of which about 70% are ischemic strokes.
How to determine if an acute stroke has occurred
When a stroke is suspected, you can observe whether a stroke has occurred in the order of eyes, mouth, hands and feet.
1. Symptoms occur suddenly.
2. Loss or blurring of vision in one or both eyes.
3. Gaze to one side in both eyes.
4. Rotation of vision or balance disturbance.
5. Numbness or crookedness of the mouth on one side of the face.
6.Speech slurred or difficulty in understanding language.
7. Weakness, clumsiness, heaviness or numbness of one limb (with or without the face).
8.Severe headache and vomiting which were rarely seen before.
9. The above symptoms with impaired consciousness or convulsions
What are the treatments for acute stroke
The treatment varies for different types of stroke. The most common type of stroke is cerebral infarction, which requires a high level of treatment in the acute phase. For patients with cerebral infarction, the most important thing is to seek medical attention as early as possible after the onset of the stroke. Because the more recognized treatment for acute cerebral infarction worldwide is early revascularization, the methods of revascularization include drug intravenous thrombolysis, intra-arterial injection thrombolysis, and mechanical device to remove the thrombus, etc. However, no matter which method is used, it is required to be performed in the shortest possible time. The best time for intravenous thrombolysis is within 4.5 hours after onset, arterial thrombolysis is required to be started within 6 hours after onset, and the longest mechanical device to remove the clot is only suitable for patients with onset within 8 hours. Therefore, the earlier a brain infarction is seen after its onset, the more treatment options are available.
These treatments include.
1. Thrombolytic therapy: including intravenous thrombolysis and arterial thrombolysis
Intravenous thrombolysis: recombinant tissue-type fibrinogen activator (rt-PA) by intravenous injection is an effective treatment for cerebral infarction in the acute phase. Intravenous rt-PA therapy is currently the only FDA-approved treatment for acute ischemic stroke. It is suitable for the treatment of patients with acute cerebral infarction within 4.5 hours of onset (rt-PA). This treatment can lead to a chance of recovery in 15% of stroke patients.
Arterial thrombolysis: Patients within 6 hours of onset may be treated by arterial thrombolysis if the physician suspects a large intracranial vessel occlusion. This method involves making a small 2-3 mm hole in the artery at the base of the thigh, then inserting a microcatheter less than 1 mm into the thrombus and injecting thrombolytic drugs inside the thrombus. This allows direct contact between the drug and the thrombus, but the operation is relatively complex and requires an interventional minimally invasive procedure, and is therefore performed only in larger stroke centers.
2.Embolysis by mechanical device
Cerebral infarction caused by occlusion of large intracranial vessels with a large area of brain tissue necrosis can easily lead to death or severe disability of the patient. Some data show that the mortality rate of such patients exceeds 40%, and most of the remaining patients are severely disabled for life. There are now newer treatments for such cases – special embolization devices are used to remove the clot. These methods can be used for those patients with suspected intracranial artery occlusion within 8 hours of onset, and the treatment is also applied with minimally invasive interventional methods. Foreign literature reports and our previous experience have found that about 90% of patients can be opened with such methods to open the occluded vessels, and more than 40% of them can get a better recovery.
3.Anti-platelet drugs
If unfortunately you have already exceeded the best treatment time when you visit the hospital, or the doctor thinks you exist when you can’t apply the previous kinds of treatment, you don’t need to rush. For ischemic stroke patients who are not eligible for thrombolysis should be given oral aspirin 150-300 mg/d as soon as possible after the onset of the disease. after the acute phase (4 weeks), this can be changed to a prophylactic dose (50-150 mg/d).
4.Anticoagulation therapy
For cerebral infarction within 48 hours of onset, anticoagulant drugs such as heparin and low-molecular heparin can be considered. If the cause of cerebral infarction is heart-derived emboli, the main application of oral anticoagulant drugs is to prevent recurrence, the most commonly used being warfarin tablets.
5.Lipid-regulating drugs
This drug not only can play a role in lowering blood lipids for elevated blood lipids, but also can stabilize atherosclerotic plaques by lowering LDL. Therefore, regardless of the presence of high blood lipids, as long as there are atherosclerotic plaques, such drugs can be taken.
6.Other acute drug treatment methods
In addition to the above-mentioned methods, doctors may also choose Chinese medicine treatment, microcirculation improvement, neurotrophic drugs and brain protection according to the patient’s condition, and other drug treatments with different mechanisms of action.