Clot in brain removed, doctors stress early intervention in stroke cases

October 27, 2012 12:00 am | Updated 04:59 am IST - COIMBATORE:

‘Trial done this year found that it is safe to thrombolyse even within six hours’

Fifty-five-year-old Ponnusamy was lucky that he reached a hospital in one-and-a-half hours since he suffered a stroke a week ago. He landed at Kovai Medical Center and Hospital in the city with immobility of the left hand and leg because the right side of the brain was affected. A clot in the artery supplying blood to this portion of the brain was the reason.

A week since then, the patient holds his plate of lunch with the left hand that was rendered immobile by the stroke.

Not many can be as lucky, Chairman of the hospital Nalla G. Palaniswami and Neurologist K. Vijayan told presspersons here on Friday. Technology had improved to the extent of allowing a time window of six hours to begin treatment, from the moment of occurrence of the stroke. But, earlier the better if the results had to be as good as that of Ponnusamy.

The neurologist used a combination of drug and ultrasound waves to dissolve the clot in the blood vessel. “Earlier, only drugs were used to dissolve the clot. For the last four years, sono thrombolysis has gained ground in treating such cases,” Dr. Palaniswami said. (Thrombosis is the clotting of blood and thrombolysis is the procedure to dissolve it.)

Elaborating on this method, Dr. Vijayan said tissue plasminogen activator (TPA) was sent through a blood vessel in the hand or the thigh to the affected spot in the brain. Simultaneously, ultra sound waves from the transcranial Doppler quickened the dilution of the clot. This was twice effective than the drug-alone method.

After the hour-long procedure, Mr. Ponnusamy raised his left hand, Dr. Vijayan said, showing a video clipping. Present at the press conference, the patient raised his hands and walked around to demonstrate the efficacy of the procedure.

“The time taken to bring the patient in will determine the time taken for recovery,” Dr. Vijayan said.

“There was no blood flow in the affected artery at the time when Mr. Ponnusamy was admitted. There is normal flow now,” the neurologist said, emphasising early intervention.

People must be educated on picking up the initial symptoms such as weakness in limbs and the attendant imbalance, incoherent speech and facial contortion, the neurologist said. Uncontrolled blood pressure, diabetes, smoking and cholesterol were the common factors.

Touching upon the method of treatment, Dr. Vijayan said patients stood to gain from drug and sound waves combination – a marked improvement from the days (the 1980s) when streptokinase and urokinase drugs were the only option, but with very little success.

The TPA was then developed and introduced in the U.S. in 1995. Europe cleared it for use in 2003, but fixed the treatment time window at three hours. Another trial in 2007 helped increase it for four-and-a-half hours (from the time of the stroke). “A major trial done this year found that it is safe to thrombolyse even within six hours,” he said.

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