Basics of stroke and neurointerventions (part of STNI press kit for conference)

1. SOCIETY OF THERAPEUTIC
NEUROINTERVENTIONS

2. What is stroke and what causes it?
• Stroke is a disease that effects the blood vessels going to the brain
• Stroke happens when blood vessel going to the brain gets blocked by a clot or
bursts.
• As a result of it part of brain doesn’t bet oxygen and blood it needs and dies
• It is 3rd
most common cause of death and disability
ISCHAEMIC STROKE
HEMORRHAGIC STROKE

4. Why is it an emergency?
• Most common reason for disability
• Appx. 1 in 4 people die within 1 year
• 30%–50% do not regain functional independence
• Annual incidence rate of stroke in India currently is 145 per 100,000 population
• 10 - 15% occur in < 40 years
• WHO estimates suggest that by 2050, 80% stroke cases in the world would occur
in low and middle income countries mainly India and China

5. Why do we say “time is brain’
• Every minute if stroke is untreated, the average patient loses 1.9 million neurons,
13.8 billion synapses, and 12 km (7 miles) of axonal fibers.
• Each hour, in which treatment fails to occur, the brain loses as many neuron as it
does in almost 3.6 years of normal aging.
• Early treatment in first few hours can reverse stroke in many patients

6. How can one know that stroke is
happening?

7. Beyond F.A.S.T. –
Other Symptoms You Should Know
• Sudden numbness or weakness of the leg
• Sudden confusion or trouble understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

8. What should be done if stroke is
happening?
• Immediately go to a hospital which can do stroke treatment
• Do not wait for improvement
• Do not spend time at local GP
• Don’t take BP medicine
• If CT doesn’t show any bleed, Aspirin tablet

9. Is it possible to reverse stroke?
• If the blocked blood vessel can re-opened brain tissue can be saved
• If patient comes in first few hours (4.5 hrs), clot busting drug (t-PA) cab ne
given
• Blood vessel can also be opened by intervention technique
• Neurointerventionist goes through leg blood vessel and by special devices can
take out the clot to open up the blood vessel
• By modern treatment methods may patients recover completely after stroke
Is it possible to prevent stroke?

10. CLOT REMOVAL
BY NEUROINTERVENTION

11. What is mini-stroke and why is it
important?
• “Mini stroke” or Transient ischemic attacks “TIAs” are temporary blockage of
brain blood vessel
• In these cases stroke symptoms are present for short period
• If treatment is no started many patients develop permanent stroke
• “Mini-stroke” is an emergency and person should immediately go to stroke
specialist
• Treatment can prevent permanent stroke from happening

12. What are brain aneurysms?
•Brain aneurysms are weakness “ballooning” of blood vessel of brain which
burst to cause bleeding in brain
•The aneurysms have to be repaired urgently to prevent repeat bleeding
•Nowadays most cases can be treated by minimally invasive
Neurointervention technique which are safer than open surgery
• COILING
•In this procedure metallic rings are placed in the aneurysm to repair the
weak spot. The procedure is known as “coiling”

13. COILING

15. Is intervention and surgery possible in brain
blood vessels the same way as done in heart?
• Many patients have cholesterol deposit in blood vessel to brain- this is called
“carotid stenosis”. If stenosis is severe, it causes stroke.
• It is possible to remove the blockage by stent placement, same way as in heart
• This a short procedure which is done with local anesthesia
• Surgery can also be done to remove the cholesterol deposit.
Plaque
(yellow
)
Ste
nt

16. Interventional Surgery
• The role of neurointervention technique of mechanical recanalization in
acute stroke has been proved to be strongly positive by the recently
publishes trials (MR CLEAN from Netherlands, ESCAPE from Canada,
EXTENS-IA from Australia, SWIFT_PRIME from USA, and REVASCAT from
Spain). The articles were published in New England Journal of Medicine in
2015.
• These studies have shown that when a major blood vessel of brain is
blocked then the clot removal by neurointervention technique can result
in restoration of blood flow which helps in reviving brain
cells leading to better recovery.

17. Interventional Surgery
• Since the results have been uniformly and strongly positive in
all the studies, American Stroke Association and American
Heart Association have approved these procedures with
strongest level of recommendation
– class 1; level of evidence A. According to the published
guidelines, patients with occluded major blood supply to
brain can be treated by this procedure if it can be started
upto 6-hours of onset of symptoms.

18. STNI – Society Patrons
Prof NK Mishra Prof AK Gupta Prof R V Padke
Dr Anil Karapurkar Prof N Khandelwal

19. STNI – Office Bearers
President Vice President Vice President
Santosh Josheph Mathew Cherian Shailesh B Gaikwad
Secretary Joint Secretary Treasurer
Uday S Limaye Vipul Gupta Manish
Shrivastava

20. STNI – Executive Committee
Harsh Rastogi Hirdesh Sahni Jayadevan E R
Shyam Kumar NK Sukalyan Purkayastha Sunanda Anand
Vivek Gupta

21. Conference Organizers
Chief Patron Organizing Chairman Organizing Committee
Naresh Trehan Vipul Gupta Aditya Gupta
Sumit Singh
Patron Organizing Secretary Harsh Sapra
Ajaya Nand Jha Gaurav Goel

22. Dr Ajay K. Wakhloo
MD ,PhD ,FAHA
Professor of Radiology, Neurology and
Neurosurgery
Director, Division Neuroimaging and
Intervention (NII)
Department of Radiology
University of Massachusetts , USA

23. Dr Naci Kocer
MD
Professor, Neuroradiology
Istanbul University
Istanbul, Turkey

24. Thank You