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Published on July 19, 2022

illustration of a constricted and narrowed artery

Latest Stroke Treatments Lead to Better Outcomes

Strokes continue to cause an American death about every 3 minutes, yet new treatments are developed all the time to help patients recover.

“In just a decade, we’ve seen exponential growth in understanding of stroke and treatment,” said neuro-hospitalist physician Srinivas Bandi, MD, Avera Medical Group Neurology.

A stroke occurs when a blood clot or bleeding inside the skull impacts the brain. There are two types of stroke:

  • Ischemic strokes – a term for a blocked blood vessel
  • Hemorrhagic strokes – where bleeding stops brain cells from getting oxygen and nutrients

“The sooner the signs are noticed and emergency care begins, the better,” Bandi said.

Stroke Warning Signs

Strokes can happen to anyone of any age at any time. Seek help immediately by calling 911 or find an Avera emergency department near you.

Classic symptoms of stroke include:

  • Sudden onset of numbness or weakness in the face, arm or leg, especially on one side of the body
  • Confusion
  • Trouble speaking, seeing or walking
  • Loss of balance or coordination
  • Severe headache

Immediate Response to Stroke Still Vital

The first step when a possible stroke patient arrives in the emergency department is CT imaging to determine exactly what type of stroke happened and where. Those crucial images then direct timely treatment for less long-term damage to the brain.

Some patients are candidates for interventional neuro-endovascular procedures. These involve highly advanced operational tools and imaging technology that allow for a minimally invasive approach to neurovascular conditions including stroke.

Neuroendovascular surgery is among the newer sub-specialties in the United States, as well as the world

“Without proper oxygenated blood supply, parts of the brain can die fairly quickly, within a matter of minutes,” said Alex Linn, MD, neuro-endovascular surgeon with the Avera Brain & Spine Institute. “The field of neuroendovascular surgery answers a much-needed calling to address some of the most critical medical emergencies in all of medicine, which previously were untreatable.”

How Surgery Addresses Stroke

Via micro-catheters and wires, tiny equipment is navigated through blood vessels via a remote incision about a quarter of an inch or less in the wrist or the groin.

Once at the site of the stroke, various tiny tools and devices are used to either open an occluded critical vessel or repair an abnormality. Surgical clot retrieval via neuro-endovascular surgery is an option in ongoing stroke care, for example, if tPA did not sufficiently break down a clot.

Tissue plasminogen activator (tPA) is also known as “clot-buster” drug treatment. If appropriate, patients receive the infusion that uses enzymes to break down blood clots.

“In the past, only a small fraction of patients received it,” Bandi said. “It can be used in more patients now, as we have better evidence on our approaches.”

Avera emergency physicians now use a new medication, tenecteplase, for certain strokes, and it’s a preferred choice for its medication safety and speed.

After the ER, Stroke Treatment Continues

Patients begin to recover in a critical care setting or specialized neuro unit. Then for many patients, inpatient rehabilitation is the next step where a wide range of methods are used to help ensure memory, balance and mobility return after a brain attack.

“Patients in rehab often have to relearn everything from getting dressed, to getting in and out of a car. They have had their whole lives turned around,” said Thomas Ripperda, MD, Avera Medical Group physical medicine and rehabilitation specialist.

Avera opened its state-of-the-art rehab unit on the fifth floor of the Prairie Center in Sioux Falls in 2018, and it features elements that help patients relearn life activities. For example, a restaurant booth, curb ramp, and tub rooms where patients can practice getting in and out of a tub.

In a therapy gym, patients can regain function using advanced equipment, such as Functional Electrical Stimulation (FES) lower extremity and upper extremity bikes, and a specialized harness system to protect patients from falling as they work on mobility.

Stopping Stroke Before It Happens

COVID-19 added another threat related to stroke.

“Current information shows COVID-19 it is known to increase the risk of stroke by 3 to 6 times in the first week of the infection,” Bandi said.

That risk remains high in the first month after the illness in both older adults and people 50 and younger, too.

For most people, one inexpensive piece of medical equipment could be a game-changer.

“Every family should have a blood-pressure cuff at home, and use it,” Bandi said. “Knowing your blood pressure – and taking steps to lower it can save lives.”

Beyond that, you can help prevent strokes by not smoking, exercising more and eating a healthy diet. “We’ve improved what we can do to help, but it’s better to stop strokes beforehand,” said Bandi.

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