Emergency Treatment for Ischemic Stroke - Dr. Reza Jahan | UCLA Interventional Radiology

hello I'm dr. Reza Jahan I'm an interventional neuroradiologist at the UCLA Medical Center today I want to talk to you about ischemic stroke in particular emergency treatment of ischemic stroke this is a particular topic that is of interest to me both of my clinical work and in my research let's begin by definition of stroke what is a stroke a stroke is best defined as sudden impairment in brain function an area of the brain is injured and depending on what it controls in our body the symptoms will be manifested based on that so for example if the area of the brain that's injured controls strength then weakness and paralysis will be the symptom if the area of the brain injured controls sensation then numbness can be a symptom vision problems speech problems these are all symptoms of a stroke now what can cause such as sudden impairment of brain function what can cause you to have sudden symptoms like that well there are two causes for stroke which I have outlined here there are two causes for stroke one of which is called ischemic stroke and that's the majority of strokes and the other is called hemorrhagic stroke and that is about 15% of strokes are hemorrhagic strokes and I'll define each of these what they are ischemic stroke is a type of stroke where there is a blockage in a blood vessel in the brain this blockage of a blood vessel in the brain deprives a portion of the brain from oxygen and nutrients and that portion of the brain then is potentially injured depending on what controls the symptoms will be related to exactly that so if this controls strength this person will experience weakness or paralysis alternatively a hemorrhagic stroke is when a blood vessel in the brain bursts and there's bleeding in the brain so different from an obstruction of blood flow here the bleeding in the brain is what injures the brain tissue and causes symptoms today we're going to be talking about ischemic stroke which is caused as I mentioned by obstruction of blood flow typically by a blood clot now is there emergency treatment available for stroke because this ischemic stroke is indeed an emergency situation and indeed there is up until two years ago there was only one treatment actually available and this treatment was approved back in 1995 and the treatment was a drug a drug called TPA a clot buster that is administered the function of which is to dissolve the blood clot and hence open up the clogged artery this was approved back in 1995 and the drawback of the drug treatment is that it has to be given very fast after your symptoms begin in the base situation it has to be given about four and a half hours after your symptoms begin beyond four and a half hours not only is it not going to help you with recovery but it may even be harmful so to give this truck within four and a half hours look at everything that we need to go through to get to the patient and administer this drug for four and a half in four and a half hours first the patient has to experience symptoms and recognize that those symptoms are stroke symptoms call 9-1-1 the emergency medical services will then go to the patient's residence or work or maybe in a shopping center or in a shop pick up the patient transport them to a hospital where the patient will have to go undergo emergent evaluation including some imaging studies to confirm that it's an ischemic stroke because you do not want to give a cut Buster drug to somebody who's having a hemorrhagic stroke once you confirm that it's an ischemic stroke then the drug can be given all of this has to happen within four and a half hours which is rather challenging most of the delay in most people is in recognition of the symptoms of a stroke and in calling 9-1-1 because it's very difficult sometimes to call 9-1-1 and talk to the operator when you're having a stroke yourself so often patients that have a stroke are discovered by family members or other people and then they call 9-1-1 so it delays here lead to delay in arrival in the hospital and many people miss this four and a half of our time point to get this drug and who just for the struck to be effect so lot of research and investigation went into other strategies to treat ischemic stroke patients beyond this 4 and 1/2 hour time window this is where my area of expertise comes in and endovascular treatment was a procedure that showed benefit in ischemic stroke patients as early as 3 years ago it's only since 2015 that this particular treatment strategy has shown benefit in ischemic stroke patients so we had the clot busting drug since 1995 and then nothing else for ischemic stroke patients till about three years ago in 2015 now endovascular treatment is a minimally invasive treatment this is my area of expertise as an interventional neuroradiologist and this procedure is done by threading a catheter through the leg artery all the way up into the brain arteries so we thread a catheter which is a long thin soft plastic tube from the artery in the leg all the way up into the artery in the brain all the blood vessels in the body are connected so we can start in the leg and go anywhere in the body in this case we go into the brain once we're in the brain with this catheter we inject dye through the catheter to visualize the blood vessels in the brain and we confirm that there's an obstruction in the blood vessel in the brain in this case the obstruction is right there that's an obstruction of a blood vessel called the middle cerebral artery this person would be having the symptoms this person would be experiencing would include right-sided paralysis right-sided numbness and inability to speak and they would be partially blind in their part of their visual field so this person would be experiencing a very severe stroke with this kind of a blood vessel blockage we go up into the blood clot that is obstructing the blood vessel with these catheters again and deploy a device these devices imaged here that are FDA approved for treatment of ischemic stroke patients these devices literally grab the blood clot they grab the blood clot and we pulled the blood clot out opening up the clogged artery so that restoration of but flow and nutrients to the brain can resume and this will hopefully abort the stroke and that is how this minimally invasive procedure is done now this is an example of a patient I treated and this is a picture of the blood vessels in the brain called an angiogram and the obstruction is outlined by the red arrow here's the obstructed blood vessel there is a small branch down here but the major blood vessel branches here are all missing and I'll show you what it looks like after we opened the clogged artery so you can see the difference notice that after we opened the clogged artery with our devices now all these blood vessels that were previously not flowing not visible are now visible and the obstruction has been relieved there's a restoration of blood flow restoration of oxygen and nutrients delivered to the brain tissue this person could have ended up with a severe paralysis and severe neurologic deficits and ended up in rehabilitation possibly not survive instead they walked out of the hospital in a few days and so this is really a life-saving procedure for patients who are suffering from ischemic stroke now one thing I want to emphasize is that the time to treatment is of prime importance we always say time is brain we can do these procedures these endovascular procedures up to six to eight hours after somebody has beginning of symptoms of a stroke in some people we can even do it up to 24 hours but that doesn't mean that we take our time to treat these patients we rush to treat these patients as fast as possible because all of the clinical trials have shown that the faster you get treatment the greater your probability of making a complete recovery and here's some data from a clinical trial I want to share with you this is combined data from two large trials which shows that the probability of a good outcome declines as you are further and further out from your symptom onset so if your symptoms begin here you're and you get treatment right away your chance of recovery is excellent if you get treatment way out here your chance of a recover is very very low let me show you that in real numbers if you come in and get treatment in three hours add three hours 180 minutes your chance of a good recovery is close to 80% now let's say you're delayed you come in at five hours just a two hour delay and your chance of a good recovery now is only sixty percent so you go from at three hours 80% chance of a complete recovery to five hours 60% chance of a complete recovery and the further out you are from symptom onset to receiving this life-saving treatment the lower your probability of a good outcome this emphasizes the importance of recognizing stroke symptoms and calling 9-1-1 to get to the emergency room as fast as possible the acronym we'd like to emphasize for our patients is the acronym fast which goes as follows F stands for face if your face is uneven then that could be a sign of a stroke a is armed if your arm is weak or paralyzed S is for speech if your speech is strange you have trouble speaking you have trouble understanding speech time T is for time time to call 9-1-1 fast face arm speech problems time to call 9-1-1 and get to the emergency room right away now at UCLA Medical Center we are a comprehensive Stroke Center which means that we are certified to take care of the most severe and complex stroke patients and this is a endeavor that is undertaken by more than 40 members of the comprehensive Stroke Center myself and all of my colleagues and we are available 24/7 365 days a year to urgently and emergently evaluate patients with stroke and treat them let me walk you through what happens when a stroke patient arrives at UCLA and show you the workflow that we go through and how urgently we evaluate and treat these patients to ensure that we maximize the chance of a good outcome for these patients so first of course you recognize your strip-searched symptoms you call 9-1-1 the ambulance comes and picks you up on route to the hospital the ambulance calls UCLA and says have a stroke patient were on route to you this immediately alerts our alerts our brain specialists our neurologists to go to the emergency room and await arrival of that stroke patient in the emergency room once you get off the ambulance there is a quick evaluation in the emergency room where you're given a quick examination blood is drawn to I make sure the IV is in place and then we go to rush to imaging we rush to imaging because we need to do imaging to decide whether this is an ischemic stroke or a hemorrhagic stroke that's very very important in what kind of treatment you end up getting depending on which type of stroke it is so we go to imaging and we have very sophisticated imaging that we perform both in M R and in CT we're in with very sophisticated software we get an idea of how much brain tissue is already damaged and how much brain tissue is at risk so this is an example of such an image where on this half we see the red colored portion of the brain which is a very small area of the brain that is colored that is already damaged this brain tissue that is colored is already damaged that's a very very small amount that's already damaged on the green on this side the green shows how much brain tissue is at risk for potential damage if the patient doesn't get treatment you can see that there is a very large volume of brain tissue that is at risk very small volume that's already damaged a very large volume that is at risk for potential damage if we don't treat the patient so the combination of clinical data imaging and examination is what determines whether a patient is eligible for this treatment this patient was deemed eligible for treatment and therefore we rush to the procedure room where we go up through the groin again and get up to the blood vessels in the brain do a catheter angiogram where we inject dye and confirm there's an obstruction then we use our devices to open up the obstruction and you can see that the blood vessels that were missing before are now reopened and this will abort the stroke and this will give the patient the best opportunity for a good recovery and the patient after the procedure goes to the intensive care unit where our neurology ICU specialists then manage that patient after the procedure and hopefully patient will go home after that because of the treatment so you come to the emergency room we greet you in the emergency room and this we do 24/7 365 days a year we're always available in the hospital to go to the emergency room to make sure that we rapidly rush the patient through these procedures you go to imaging go to a procedure room open up the clogged artery and go to ICU now this rapid evaluation and treatment by expert team of physicians is to ensure the best outcome for our skimming stroke patients stroke is a medical emergency if there is one takeaway that I want you to remember from my talk it's that stroke is a medical emergency recognize the signs and symptoms of a stroke that's fast face arm speech problems time to call 911 and get to the emergency room as fast as possible to get treatment stroke is the medical emergency and myself and madam and my colleagues are available 24/7 365 days a year to emergently evaluate and treat stroke patients at UCLA thank you [Music] you

Channel: UCLA Health

Views: 240,709

Keywords: UCLA Interventional Radiology, Dr. Reza Jahan, Ischemic Stroke, stroke treatment, stroke, what is stroke, interventional neuroradiology, neuroradiology

Id: n1qL12UGJt0

Length: 14min 50sec (890 seconds)

Published: Mon Jul 23 2018