Blood vessels are like pipes, and like your plumbing, there are two basic ways they can go wrong
When my mother suffered a serious disabling stroke 15 years ago, a stroke that ultimately killed her, there wasn’t much that medicine could offer. The stroke happened while she was eating dinner with my brother and his fiancé, who prompty called an ambulance. But even immediate treatment at a medical center made little difference for her.
Stroke remains the third leading cause of death in the U.S., and the No. 1 cause of disability. But new developments in stroke treatment are beginning to make the outlook for stroke victims less bleak.
Stroke occurs when something runs amok with the vessels that supply blood to the brain. The brain requires a steady supply of oxygen and fuel (glucose) to operate, and begins to malfunction and die as soon as its supply is disrupted. Blood vessels are like pipes, and as with your plumbing, there are two basic ways that they can go wrong. First, they can leak and burst. Second, they can become clogged and blocked.
A common source of bleeding is a berry aneurysm. Think of this as a weakened area of a blood vessel that balloons out over time. The defective area where the aneurysm fails is probably congenital, something the patient is born with. Risk factors include a family history, certain genetic diseases that affect connective tissue, head trauma, high blood pressure, infection, tumor, atherosclerosis and cigarette smoking.
Most berry aneurysms don’t cause any symptoms until they rupture and hemorrhage. At that point symptoms can include headache, weakness, trouble speaking and confusion. A few patients’ aneurysms leak slowly first and produce a warning “sentinel” headache. Occasionally a berry aneurysm is discovered incidentally when a patient undergoes testing to evaluate an unrelated condition.
One treatment is brain surgery. The surgeon carefully removes a segment of the skull, then opens the covering of the brain, and finally attempts to carefully locate the aneurysm. Once located, the aneurysm is clipped: a special metal device seals off the aneurysm where it bulges from the blood vessel.
Of course, brain surgery is invasive. So an exciting new technique is beginning to be used more often. Called endovascular embolization, it begins with the surgeon threading a flexible hollow plastic catheter into the groin. The catheter is carefully threaded through the vascular system until it reaches the berry aneurysm. Next a guide wire is threaded through the catheter and used to position tiny coils of platinum wire inside the aneurysm. Eventually the aneurysm is filled with more coils, which cause the blood inside to clot and destroys the aneurysm. The whole setup is tiny, with a catheter smaller than the tube inside a Bic pen and the wire scarcely bigger than a human hair!
The second way that a stroke can occur is when the pipes become clogged. One way this can happen is when a blood clot breaks loose from somewhere upstream, perhaps from a blood clot within the heart. It’s similar to what happens when your kid drops a toy into the toilet and it becomes stuck when it can’t negotiate the curve in the drainpipe. Or the build- up of plaque can gradually narrow an artery to the point where a blood clot forms in the narrowed segment or the plaque itself ruptures and blocks the artery. Strokes caused by any form of blocked blood flow are called ischemic strokes, and are the most common type of stroke.
One treatment for this type of stroke is to use a drug that can dissolve blood clots. It’s like pouring in drain cleaner. But this type of treatment can be problematic: there is an increased risk of bleeding elsewhere in the body, and there are lots of situations where these drugs aren’t safe, such as after recent surgery or in a patient with ulcers.
Now, in selected cases, surgeons can actually thread a catheter to the blocked area, and then use tiny wires to snare the clot, pull it back (like reeling in a fish) and then suck it out with a tiny suction catheter.
Thanks to these new techniques, modern medicine is beginning to succeed in treating a condition that only a few years ago carried a uniformly grim prognosis. Stroke is still a serious dangerous disease. The ultimate goal would be to prevent stroke from happening in the first place. We’re not there yet, but stopping smoking and controlling high blood pressure, high cholesterol, and diabetes definitely helps.
Even the most exciting new technologies can help only if started as soon after the onset of a stroke as possible. Think of it as a brain attack. Like a heart attack, stroke is an emergency. If you believe your family member, friend or coworker is having a stroke, call 911. Don’t waste time by waiting, or by driving to a doctor’s office.
Signs of a stroke, according to the American Stroke Association, are:
• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or coordination.
• Sudden severe headache with no known cause.