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Acute Ischemic Stroke

An ischemic stroke occurs when a blood vessel in the brain becomes occluded. It is sometime also referred to as a cerebral vascular accident (CVA.) The part of the brain that was relying on the vessel that has become occluded for blood flow will cease to function properly. If the occlusion is not treated, that part of the brain will infarct, or die, within a period of hours.

Symptoms

A patient may experience blurred vision, paralysis, weakness, numbness, vision problems, balance or coordination problems, or speech difficulties. If these symptoms resolve quickly, the incident is called a transient ischemic attack, or TIA. If they persist, it is called an ischemic stroke. If you suspect someone is having a stroke, you should call 911 immediately. EMS will know which hospital nearby is a stroke center.

Diagnosis

Ischemic stroke can be diagnosed on a CT scan. Further studies like CT-angiogram or MRI or MRA can give much more detailed information about exactly which vessel is occluded and exactly which brain is at risk for infarction.

Treatment

  1. Intravenous tPA: If a patient arrives at the hospital within 3 hours of the onset of symptoms, the can receive an injection of tissue plasminogen activator (tPA.) This drug dissolves clots. Patients must have a CT scan of the head in order to receive tPA to make sure the patient is not suffering from an intracranial hemorrhage, for which a clot-busting drug would be contraindicated.
  2. Thrombectomy: Patients who fail to improve after the administration of IV tPA or who are not candidates to receive the drug can undergo thrombectomy. Thrombectomy is an endovascular therapy in which surgeons thread a catheter within the blood vessels up to the occlusion. Next, one of many different devices is deployed to grab, suck, or remove the clot or occlusion. This re-establishes blood flow. The Neurosurgical Hybrid Operating Suite at VCU offers surgeons the ability to perform real-time CT scanning before, during and after the procedure to detect which brain has already infracted and is unsafe to revascularize or early detection of intracranial hemorrhage.

The picture on the left demonstrates an occluded middle cerebral artery. The picture on the right demonstrates successful thrombectomy on the same artery and filling of the middle cerebral artery.

The picture on the left demonstrates an occluded middle cerebral artery. The picture on the right demonstrates successful thrombectomy on the same artery and filling of the middle cerebral artery.

Patient Resources

American Stroke Association: www.strokeassociation.org/STROKEORG/