Acute stroke treatment

December 01, 2017 15:31
There are over 30,000 new cases of stroke in Hong Kong each year. On average, one in six people will be at risk of getting a stroke. Photo: Reuters

Stroke is an irreversible impairment of the brain caused by obstruction of blood supply. It can happen without warning and the patient’s condition can deteriorate in a short period of time.

It can also cause permanent disability and even death, posing a heavy burden on families and society.

There are over 30,000 new cases in Hong Kong each year. On average, one in six people will be at risk of getting a stroke. It is the fourth leading cause of death in the city: more than 3,000 people die from it each year.

About 80 percent of the cases are classified as ischemic stroke, which is due to the lack of blood supply, while the other 20 percent are hemorrhagic, which is due to the bursting of blood vessels.

Once blood supply to the brain is blocked, about two million brain cells will die every minute. That said, the goal of acute stroke treatment is to restore blood supply to the brain as soon as possible to reduce permanent damage.

Within the first three hours from the onset of stroke symptoms, a blood clot dissolving agent can be injected to unclog a blocked blood vessel and thus help restore patient's mobility.

At present, this service is available in both major public and private hospitals in Hong Kong.

However, this treatment is not suitable for patients who recently have had upper gastrointestinal bleeding, have undergone a major surgery or are currently taking anticoagulants, which prevents or reduce blood coagulation.

Moreover, this treatment must not be used after the first three hours as the dead brain cells have become fragile and will not withstand the pressure from the reopening of the blood vessels, which will result in bleeding. It is also not ideal for treating blockage in major blood vessels.

In these cases, mechanical thrombectomy, a minimally invasive surgery can be used. Surgeons will use a micro-catheter device to pass through the vessels from the groin. With the X-ray monitor guidance, this can treat the exact point of a clot and restore the blood flow.

Though this treatment is more invasive, it can be used within six hours of the onset of a stroke and is more effective in dissolving clots in major blood vessels.

With an increased understanding of the relationship between ischemia and treatment risk, recent studies have shown that treatment can even be extended to within 24 hours of the onset of the symptoms, greatly improving the chance of cure.

Ultimately, the most important thing is to detect the symptoms of a stroke early enough and seek medical treatment as soon as possible. Immediate action is crucial to save the patient's life.

This article appeared in the Hong Kong Economic Journal on Nov. 20

Translation by John Chui

[Chinese version 中文版]

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FHKAM (Surgery), specialist in Neurosurgery.