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Treatment Options in Acute Ischemic Stroke

Each year, more than half a million Americans suffer from strokes. A stroke, or "brain attack," occurs when the blood supply is cut off from part of the brain.

When this happens, the blood-deprived brain loses its supply of oxygen and nutrients. When the brain is deprived of blood for even a few minutes, it begins to die.

There are two types of stroke-ischemic and hemorrhagic. In ischemic strokes, brain arteries become blocked and prevent blood from nourishing the brain.

In hemorrhagic strokes, brain arteries rupture from damage caused by high blood pressure and other risk factors or an aneurysm (an abnormal out pouching of a blood vessel) and cause blood to flood the brain, creating pressure that leads to brain-cell death.
There are many risk factors that increase the risk of stroke.

Some factors can be controlled, while others cannot. Some of these factors include: high blood pressure, high cholesterol, heart disease, diabetes, heavy drinking, smoking, being overweight, and a family history of stokes.

Ways to reduce these risks include: not smoking, limiting alcohol intake, controlling your weight and blood pressure, and finding out if you have an irregular heartbeat or a diseased carotid artery. Immediate treatment of a stroke may limit or prevent brain damage.

A thrombolytic agent or "clot buster" medication may be given within the first 4.5 hours of the onset of stroke symptoms, and patients may also qualify for emergent endovascular therapy to try to open blocked blood vessels.

It is critical to call 911 and get to the hospital quickly if you experience stroke symptoms.

Listen as the experts from Cleveland Clinic give you the most up to date information on Acute Ischemic Stroke and how acting fast can save your brain!

We're Talking About Your Health with Cleveland Clinic!
Treatment Options in Acute Ischemic Stroke
Featured Speaker:
M. Shazam Hussain, MD, Cleveland Clinic Cerebrovascular Specialist
M. Shazam Hussain, M.D, is the designated stroke center director and staff physician in the Cerebrovascular Center at Cleveland Clinic. He received his medical degree from University of Saskatchewan College of Medicine in Canada and then went on to complete a residency and fellowship at University of Alberta Hospital Canada in neurology and vascular neurology. Dr. Hussain joined Cleveland Clinic for his final fellowship in endovascular surgical neuroradiology. His specialty interests include acute stroke therapy, cerebrovascular diseases, and neuroimaging.

Cerebrovascular Center at Cleveland Clinic

Melanie Cole (Host): Each year, more than half a million Americans suffer from strokes. My guest today is Dr. Shazam Hussain with Cleveland Clinic. Welcome to the show, Dr. Hussain. Tell us about stroke.

Dr. Shazam Hussain (Guest): Stroke is a very serious condition facing our population. It's estimated that it's about the fourth leading cause of death and it's the leading cause of disability in the United States.

Melanie: Tell us a little bit. There's two types of stroke that we've heard about. What exactly happens during a stroke, and is this as scary as people think it really is?

Dr. Hussain: Yeah. You're exactly right. There are two basic types of stroke. We talked about ischemic stroke, which is where a blood clot blocks the blood vessel, and you lack blood flow to the brain. There's also the hemorrhagic stroke or bleeding type of stroke, where you actually have a burst blood vessel that will bleed into the brain. The reason why we're so concerned about stroke is that it can cause pretty serious injury to the brain, which can sometimes be quite disabling and hard to recover from. But the good news is that there are treatments available and also ways to prevent strokes from happening.

Melanie: What are some of the signs and symptoms? People want to know. They have to act fast because time is brain, as you all say, and you are the Stroke Center Director at the Cerebral Vascular Center at Cleveland Clinic. So what are the signs that we should be looking for in ourselves or in a loved one so that we may act fast?

Dr. Hussain: You're actually right that time is really of the essence. We estimate that we lose somewhere in the order of two million brain cells every minute that a stroke is occurring. So really, one can't waste any time when they recognize these symptoms. We do use the acronyms FAST that would stand for FAST, F standing for face—so if you see someone with any droopiness on one side of the face or the other. A is for arm. So you ask someone to hold out their arm, and if you see the arm moving or dropping down, that could be the sign of weakness in that arm. That would be a problem. S stands for speech, so if you hear someone that's having difficulty expressing themselves or slurring their words, this is also somebody that you may need to have medical attention for. T, again, reminds us about time, that time is brain. And really, an immediate 911 call so you can get that person some medical attention immediately.

Melanie: And it is important, Dr. Hussain, to stress calling 911 instead of trying to drive someone to the hospital because now paramedics are trained in dealing with stroke right away, aren't they?

Dr. Hussain: Absolutely. There are things that the paramedics do right when they first come to the scene of where a stroke is occurring. They'll administer oxygen and make sure a person's sugar level is okay, as well as they actually will communicate with the hospital where they're going to be dropping off the patient. So really, get everybody in place and ready to go when you would, when that person the patient would be arriving at the hospital so that things can move as quickly as possible. There's also the possibility that stroke symptoms initially can be a little milder, but things can potentially get worse, and so we really want the people with expertise in strokes to be taking care of you right away. So absolutely, call 911 right away.

Melanie: And then what happens? You get to the emergency room. What is the first line of treatment that you do when you know someone is having a stroke?

Dr. Hussain: Immediately, the people who are recognized to have stroke symptoms -- and by the way, most of the time, paramedics will actually direct people to certain stroke centers that are designated by the area. But these stroke centers are attuned to what stroke symptoms are, and they are aware of the time criteria, and so they will rapidly move someone through the system. Typically speaking, a person will be brought back immediately so they can be assessed by the nurses and physicians of the emergency department, get certain blood tests drawn, which are important for the assessment of an acute stroke, and then immediately move to a CAT scan, which we then use to determine whether it's a bleeding type of stroke or whether it's a different variety. If it is then a bleeding type of stroke, typically speaking, the neurology team is also being called down at the same time as well as potentially neurosurgery doctors to deal with that situation. And on the other side, if no bleed is shown on that CAT scan, we will then move along the pathway of an ischemic stroke treatment, where we have clot busting medication such as TPA, which can be administered to a person to try to dissolve a blood clot and restore blood flow to the brain to improve someone's health.

Melanie: So then what is recovery like? How fast might they see some results from TPA?

Dr. Hussain: Sometimes, we do see people who have improved immediately with intravenous TPA. That occurs about in 10 percent of people. However, the main outcome we're looking for is actually more of a longer-term outcome. Those people who receive intravenous TPA feel much better when we look at their outcome at three months. Many more people are independent or near independent at 90 days after their stroke as compared to people who don't get the medication. Now, we also are doing assessment in the emergency room where we're seeing these patients. Often, we'll also look at their blood vessels with the CAT scan with CT angiogram. And if we see that a large blood vessel is blocked off, those people may actually be offered additional treatment in the form of intra-arterial or catheter-based treatments, where we can go up into the arteries and remove the clots out of the vessel.

Melanie: So then what is the prognosis? The outlook certainly depends on the type of stroke, how much brain tissue was damaged and what body functions may have been affected how quickly you get treated. What else? What are we looking for in our prognosis, Dr. Hussain?

Dr. Hussain: Usually, we determine a couple of things. We mentioned that it does depend a little bit upon the severity of the stroke. Although people typically think of strokes as devastating illnesses, there is also a wide range of strokes that can happen, some on the milder end and others can be more severe. We also often will use imaging things, like MRI scans, to see exactly how much injury to the brain has occurred. I think even if it is a severe stroke, it is important to remember that people can recover from a stroke. We usually talk about improvement mainly occurring in the first three months after stroke has occurred, and the sooner we see it, the better but there is certainly a long time and, with physical therapy, occupational therapy, also speech therapy, people can show drastic improvements then. And often, it's much improved by the time they will get to that 90-day point.

Melanie: And what's on the horizon for stroke treatment at Cleveland Clinic, Dr. Hussain? Because this is something that as people are living longer we might see more of, but yet you're so advanced in what you're doing there. Give us some real good news on stroke treatment today.

Dr. Hussain: Well, certainly, there's still a lot of advancement that is occurring in the field of stroke. For example, we had been focusing on how we can better treat people in that acute phase of the illness. I was mentioning about the catheter-based treatment, and we have been using additional ways to help look at the patient's brain in the setting of an acute stroke with an MRI scan to try to better determine who would be the best candidate for that kind of treatment. And we have found by using MRI scans that we can actually better select patients who are really going to benefit from that kind of catheter-based treatment, and then also, help avoid the procedure where people, for example, would have already a lot of damage and potentially the procedure could be harmful. And then we've been able to show through our data that this has improved patient outcomes. In addition, there are many other studies that we are in and other centers are also involved with that to look at how to better have people recover from stroke. There are studies going on that involve stem cell therapy to help regenerate some of those lost brain neurons that are lost during a stroke as well as just prevention, how can we better prevent strokes from happening through better control of risk factors and new medications that may be able to prevent strokes from happening.

Melanie: In just the last minute, Dr. Hussain, your best advice on stroke prevention and what to do if you are having one.

Dr. Hussain: In terms of stroke prevention, we certainly stress a person should maintain a healthy lifestyle. Make sure you get a good, healthy diet, are getting regular exercise. Especially if you have risk factors, things like high blood pressure, cholesterol, diabetes, or if you're a smoker, you should really be working closely with your primary care doctor or other physicians to try to keep those things under really good control, because we do know that by keeping these things under control, we can really prevent both stroke and heart attack. If you are in a situation where you feel like you're experiencing stroke, again, the best thing to do is to call 911 immediately, get into the hospital. And again, if your loved ones are experiencing the same thing, call 911 and get into the hospital. And remember that FAST acronym: Face, Arm, Speech and Time. If you see any of those symptoms, it's time to call 911.

Melanie: Thank you so much, Dr. Hussain. We are Talking About Your Health with Cleveland Clinic. For more information, you can go to   That's This is Melanie Cole. Thanks for listening.