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238 Cardio Diabetes Medicine 2017

Treatment of Acute Ischemic Stroke

Dr B.Kannan, DM. (Neuro)

Consultant Neurologist, Sundaram Arulrhaj Hospital,Tuticorin.
Senior Asst. Professor ,Govt Thoothukudi Medical College , Tuticorin.

ABSTRACT heart failure and venous thromboembolism) in a
Timely successful reperfusion is the most effective stroke unit staffed by specially trained personnel.
treatment for patients with acute ischemic stroke. The management of acute ischemic stroke starts
Systems of care should be optimized to maximize with the prompt recognition of the diagnosis in
the number of patients with acute ischemic stroke the field and attention is currently aimed at opti-
able to receive reperfusion therapy. mizing the time to reperfusion. In the emergency
department and the angiographic suite
INTRODUCTION
Stroke is defined as abrupt onset of neurological defi- PRINCIPLES OF ACUTE STROKE CARE
cit that is attributable to a focal vascular cause(may- The three main principles of acute stroke care
be ischemia or haemorrhagic ). According to WHO, are (1) Achieve timely recanalization of the occlud-
Stroke is the second leading cause of death in the ed artery and reperfusion of the ischemic tissue
world after ischemic heart diseases. Whereas it is the (2) Optimize collateral flow (3) Avoid secondary
third leading cause of death in India after Ischemic brain injury
heart diseases and COPD .The estimated adjusted (1) Recanalization and reperfusion are the main-
prevalence rate of stroke range, 84-262/100,000 in stay of acute stroke treatment and can reduce stroke
rural and 334-424/100,000 in urban areas(according treatment and can reduce infarct size and reverse
to 2013 data). The incidence rate is 119-145/100,000 neurologic deficits. Recanalization is defined by the
based on the recent population based studies degree of reopening of the occluded artery. Reper-
fusion is measured by the degree of flow reaching
Over the past 2 decades, the therapeutic approach to
acute ischemic stroke has been deeply transformed. the previously hypoperfused brain region. Opening
Long gone is the nihilism of former times, now the occluded artery works because, in most cases,
replaced by the excitement of proven treatment when the occlusion occurs, an area of brain tissue
options that can reverse ischemia and brings back becomes hypoperfused but is initially not infarcted.
function to patients who were otherwise destined This tissue represents the ischemic penumbra that
to death or severe disability .The wide adoption of can be salvaged if adequate blood flow is promptly
IV thrombolysis that began 20 years ago has re- reestablished. Advanced brain imaging with CT
cently been followed with clear evidence that the perfusion or magnetic resonance (MR) diffusion/
addition of endovascular treatment with mechan- perfusion can visualize this tissue at risk (penum-
ical thrombectomy can further improve outcomes bra imaging). Chemical thrombolysis with recombi-
in patients with severe neurologic deficits from a nant tissue plasminogen activator (rtPA), also known
proximal intracranial vessel occlusion. as alteplase and mechanical embolectomy with a
retrievable stent are the two evidence – based strat-
The treatment of acute stroke also includes egies to achieve reperfusion.
adequate hemodynamic management, monitoring
and management of ischemic brain edema and (2) Collateral flow is responsible for keeping the
early recognition of and therapy for systemic com- ischemic penumbra viable. It provides enough flow
plications (such as infections, cardiac arrhythmias, to prevent critical ischemia and infarction but not

GCDC 2017