July 7, 2022

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Emergency treatment of ischemic stroke

Emergency treatment of ischemic stroke

 

Emergency treatment of ischemic stroke: The treatment of acute stroke is a race against time.

Acute ischemic stroke should be treated as a medical emergency. Time is a crucial factor, and the diagnosis and treatment of patients should be rapid.

Emergency treatment of ischemic stroke
Effective treatment of acute stroke is a race against time. Most acute ischemic strokes are caused by clogging of intracranial arteries due to thromboembolism.

When the cerebral blood flow (CBF) drops to a certain level so that the survival of the tissue cannot be maintained, the timing of ischemic injury has already begun. The longer the time is, the greater the harm to the patient.

The degree of ischemic damage depends on the tolerance of specific neurons to ischemia and the relative local cerebral blood flow. Although reperfusion of the ischemic area can reduce the degree of ischemia, it can also cause neuronal damage. This process is called reperfusion injury.

Therefore, the effective treatment of acute stroke must be to reduce the ischemic injury while also reducing the degree of reperfusion injury as much as possible.

 

Recombinant tissue plasminogen activator (r-PA) can be selectively administered to patients with acute stroke, provided that the stroke occurs within 3 hours. Other drugs are currently being studied to provide more treatment options. Future research is more inclined to use drugs in combination to achieve the purpose of promoting vascular recanalization, blocking ischemic injury and preventing reperfusion injury. This article will focus on surgical interventions for ischemic stroke.

 


Surgical intervention for ischemic stroke

The prognosis of patients with large hemispheric infarction is poor. Malignant cerebral infarction can be caused by the occlusion of the end of the internal carotid artery or the proximal trunk of the middle cerebral artery. This is evidenced in animals that edema is related to the progressive intracranial pressure, which will eventually lead to brain herniation and cause death. According to clinical research and the current limited treatment methods, the role of decompressive craniectomy has been recognized. Decompression surgery can significantly reduce intracranial pressure and limit the expansion of the infarct area. The decrease in intracranial pressure and mechanical pressure causes cerebral perfusion pressure.

Experiments have proved that the timing of surgery is crucial. Animal model decompression surgery on the middle cerebral artery will promote the recovery of nerve function and reduce the infarction. Compared with the surgery after the infarction, the mortality rate is significantly reduced. The impact on the surgical outcome is still unclear, but there is evidence that young The effect of human surgery is better than that of the elderly.

At present, most of the evidence supporting the use of deboned craniectomy for acute ischemic stroke comes from case observations. According to the results of case-control analysis of partial craniectomy in the research center, it is suggested that young patients with large-scale infarction and early emergence Those with vomiting symptoms and comorbid diseases are more suitable for surgery. Compared with medical treatment alone, patients with large infarction undergoing partial craniectomy have significantly reduced mortality.

In a non-randomized controlled study, decompression surgery and medical treatment were performed in 2 patients who chose surgery and 21 patients were treated. For clear signs of left hemisphere infarction and aphasia, 2 patients had serious medical complications. The average age of patients in the operation group was 48 years old.

The mortality rate of patients in the surgery group has dropped dramatically, but there are still many problems, including the timing of surgery and the selection criteria of patients. At present, no one form of surgery has been proven to treat acute stroke, but some comprehensively designed multi-center randomized controlled clinical studies will provide us with accurate answers.

 

Conclusion

Acute ischemic stroke should be treated as a medical emergency. Time is a crucial factor, and the diagnosis and treatment of patients should be rapid. r-PA treatment of acute ischemic stroke marks the beginning of a stroke treatment revolution.

More research will provide us with different treatment options. Stroke is a very difficult disease, and clinicians must understand the latest research trends and treatment guidelines.

 

 

(source:internet, reference only)


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