Friday, November 8, 2019

Intervention up from 6 hours to 24 hours suggest the latest trials

Weekend Plus Desk :
AIncidence of stroke
ccording to The World Stroke Organisation, one in six people globally will suffer a stroke in their lifetime, with someone succumbing to the disease every 6 seconds. Stroke or a brain attack is a major global public health problem and the second leading cause of death worldwide. The Global Burden of Diseases study indicates a 26 per cent increase in global stroke deaths during the past two decades. The estimated incidence of stroke has increased more than 100 per cent in low- and middle-income countries including Bangladesh over the last five decades.
A stroke can strike anyone, any time and nearly 1.54 million people are affected by it every year.
Despite the rising incidence of stroke which affects an individual's quality of life forever or leads to death, there is low awareness about the disease, especially the fact that it is preventable. However recent demographic changes, limited awareness, sedentary lifestyle, smoking, obesity, and hypertension have challenged the prevention and treatment of stroke. Therefore, a comprehensive stroke care program that includes intensive stroke awareness and effective stroke rehabilitation is the need of the hour.
 What is a stroke?
A stroke happens when a blood vessel in the brain is obstructed or get gets ruptured. A blood clot usually develops in a narrowed artery caused by cholesterol plaque or could travel directly from the heart (if the heart is not pumping properly, beating irregularly or has a dysfunctional valve) to an artery that supplies to the brain. It affects the arteries which carry oxygen and other essential nutrients to the brain. Depriving oxygen and blood supply to the brain results in immediate cell microstructure change and stops functioning. Once the impacted part of the brain stops functioning normally, it affects the areas of the body it controls.
Stroke is of two kinds- ischemic stroke and hemorrhagic stroke. The more prevalent, ischemic stroke is an arterial blockage caused by a clot that restricts blood flow. Hemorrhagic stroke occurs when an artery in the brain leaks or bursts.
One of the primary concerns in stroke management is that most of the patients fail to reach the hospital in time. Thus, it becomes vital to know the symptoms for early detection.
These are-
-Trouble in speaking or understanding with slurring of speech
-Difficulty in vision, i.e., loss of vision, blackened or blurred vision
-Loss of balance or coordination
-Severe, sudden headache with no reason
-Numbness or weakness in the face, arms, and legs, usually on one side
 Time is brain in stroke
Since stroke affects other parts of the body apart from the brain, people experience symptoms such as the sudden onset of weakness in arm or leg, face deviation and speech difficulty. This is the reason why if identified early; the blood supply can be effectively restored within the limited time period, commonly called the window period. In stroke management, time is most crucial, and time is also the brain. This is because every passing minute following a stroke, millions of neurons die if the obstructed clot is not dissolved or removed and the lost neurons cannot be revived.
Therefore, most critical to a positive outcome for stroke treatment is the window period. The recommended window period for stroke intervention until recently was six hours. Latest trials have however extended this to 24 hours, in cases where the patient has salvageable brain tissue called penumbra. The American Heart Association and the American Stroke Association also endorse the expanded window period as the increased treatment window will consequently allow more lives to be saved and decrease suffering from life-altering disabilities.
Treatment of stroke
While traditionally, clots have been treated with clot-dissolving drugs, more recently neurointerventional and endovascular techniques using advanced devices are being utilized for treatment. Endovascular mechanical thrombectomy is one such process in which a clot is removed using a small catheter which is introduced in the body through a very small incision in the groin region within a short procedural time.  Untreated stroke has a long-term, often irreversible impact on normal body functions, daily activity, and social participation. Maintaining good health with regular exercise, optimal blood pressure, the balanced weight, and cholesterol offsets the risk of stroke considerably. Early identification of stroke symptoms and prompt treatment at a comprehensive stroke facility is crucial to treatment and cure.