Stroke and Interventional Radiology

• Obesity, high blood pressure and high cholesterol all increase the risk of stroke. These risk factors can be greatly reduced with healthy lifestyles or medication.
• High blood pressure puts pressure on the arteries, making them more susceptible to rupture and more prone to clot formation, which can block the artery.
• High cholesterol can lead to blockage in the carotid artery that takes blood from the neck to the brain. A piece of this plaque can break off and travel to the brain, causing a stroke.
• Obesity can cause high blood pressure and high cholesterol.
• Untreated atrial fibrillation causes the heart’s upper chamber to beat irregularly, which allows the blood pool and clot. If a clot breaks off and enters the blood stream to the brain, a stroke will occur.
• Sickle cell anemia makes red blood cells less able to carry blood to the body’s tissues and organs, as well as stick to the walls of the blood vessels. These cells can block arteries to the brain, causing a stroke.
• Family history
• Smoking

Computed tomography (CT). The first diagnostic test performed in the emergency room is usually a CT scan. CT uses computers to generate detailed pictures of the brain, and can confirm the diagnosis of stroke and tell

Magnetic resonance imaging (MRI) is a diagnostic test which may be performed to identify and further localize the site of the stroke and find the source. It may be able to quickly identify the area deprived of sufficient blood flow and guide further therapy. In the MR Image, the arrow points to the area affected by a stroke.

Angiography. An angiogram is an X-ray in which a contrast agent, or dye, is injected into a vein to highlight the blood vessels. With this exam, radiologists can pinpoint the exact location of blockage or bleeding in the brain. Angiography also is used to guide thin tubes called catheters to the site of the problem and administer treatments.

Interventional radiologists are a critical part of the stroke team in hospitals and are actively involved in creating more stroke teams across the country. Stroke teams generally consist of emergency room physicians, neurologists, and interventional radiologists.

For those having a stroke, it must first be determined which kind of a stroke the patient is having so the proper treatment can be given. The interventional radiologist interprets the non- contrast CT (computed tomography) imaging to determine if acute stroke patients are candidates for clot-busting drugs. CT is quick, inexpensive, and readily available.

If the stroke is determined to be ischemic (due to a blood clot), the interventional radiologist will assess what caused the clot, such as a clogged carotid or other artery, and can correct the underlying problem to prevent future strokes from occurring.

If the stroke is due to a blood clot, a clot-busting drug, tPA (tissue plasminogen activator) can be given intravenously to break up or reduce the size of blood clots to the brain. This technique must be performed within three hours from the onset of symptoms.

When therapy cannot be initiated within three hours or when treatment with tPA during the first three hours is not sufficient to dissolve the blood clot, interventional radiologists (IR) that specialize in neurological procedures can provide intra-arterial thrombolysis treatment.

Using x-ray guidance, an IR will insert a catheter through a nick in the skin at the groin and advance it through the femoral artery in the leg all they way to the tiny arteries in the brain where they place the clot-busting drug directly on the clot or to break up the clot mechanically.

When given locally this way, the tPA can be administered up to six hours after the onset of stroke symptoms. In many cases, the ambulance drivers will take a stroke victim past the three-hour window directly to the interventional radiology suite for assessment for this direct thrombolytic therapy. Often a significantly disabled stroke patient who receives this treatment can return to normal life with minimal or no after effects from the stroke.

The interventional radiologist will also assess what caused the clot, such as a clogged carotid or other artery, and can correct the underlying problem to prevent future strokes from occurring. Unfortunately, many hospitals in this country do not have stroke teams that can rapidly assess patients and provide treatment within the three-hour window. Interventional radiologists are actively involved in creating more stroke teams across the country. Stroke teams generally consist of emergency room physicians, neurologists and interventional radiologists.

Nearly half of all stroke fatalities occur before emergency medical personnel arrive.

• Stroke is a medical emergency with a narrow time frame for treatment—people should call 911 immediately.
• Strokes can be treated intravenously with the clot-busting drug, tPA (tissue plasminogen activator), if it is given within three hours of the onset of symptoms.
• Persons who have a transient ischemic attack (TIA), also known as a mini-stroke, are likely to have another one. Transient ischemic attacks cause brief stroke symptoms that go away. People often ignore these symptoms, but they are an early warning sign and 35 percent of those who experience a TIA will have a full-blown stroke if left untreated.
• Stroke is not just an older person’s disease—28 percent of strokes occur in people under age of 65.
• More men than women have strokes—although more women die from them