What 2022 Taught About Stroke Treatment

Stroke statistics are scary. Stroke is a leading cause of disability and death, and 2022 has taught us that there is a need for stroke research for better preventive measures, rehabilitation, and stroke treatment options.^1,2

Defining stroke

Strokes can be characterized by the inability of blood to flow to the brain. The lack of blood supply deprives the brain of nutrients and oxygen resulting in significant damage or death.¹ Warning signs and symptoms of stroke can include 

• severe headaches or migraines,
• trouble with motor skills like walking,
• difficulty with balance,
• sudden inability to understand speech or slurring of words,
• numbness and weakness on one or both sides of the face, arm, or leg, 
• and seizures.³

Stroke presents itself in two types: hemorrhagic and the more common ischemic stroke. Ischaemic strokes are more common as they are blockages in the arteries such as blood clots or plaque that reduce blood flow to the brain.¹ However, hemorrhagic strokes are less common as it entails the rupture of arteries, causing leakage that decreases blood supply. 

Risk factors and diagnosis

Risk factors that make a person more susceptible to strokes are similar to other heart and vascular diseases. These risk factors include hypertension, high-fat consumption, diabetes, low physical activity, unhealthy diets, and obesity.⁴ 

To properly diagnose strokes, symptoms and warning signs are not enough to deduce if someone has had a stroke. Strokes can only be diagnosed after brain imaging like CT and MRI scans. 

Stroke treatment 

Current stroke treatment aims to dissolve blood clotting and restore sufficient blood flow to the brain again. 

One treatment for ischemic strokes involves the repair of blocked arteries using image guidance.⁵  This involves placing a catheter to mechanically remove the clot, effectively resuming normal blood flow. 

Another method to resolving stroke is to inject alteplase into blood vessels. This will then chemically dissolve blood clots in arteries allowing blood to reach the brain.⁵ 

Stroke clinical trials

To understand which stroke treatment option is better for patients, two randomized trials compared mechanical removal versus chemically dissolving blood clots.² 

These trials were unable to conclude which treatment plans were better for patients with particularly large arterial blockages. Scientists then thought to use these two treatments in tandem for more aggressive medical treatment.² 

This means that the mechanical removal will reduce a significant portion of the blood clot. At the same time, adding alteplase will dissolve all remnants, reducing the possibility of build-up again.

Stroke solutions

Stroke treatments, clinical trials and research from 2022 have provided evidence-based options but raised more questions about the benefits of aggressive treatments. Surgical interventions and medications can be taxing on the patient; it is for this reason that primary and secondary prevention strategies like lifestyle management are still highly recommended in terms of strokes.

References 

1. Campbell BCV, Khatri P. Stroke. The Lancet. https://doi.org/10.1016/S0140-6736(20)31179-X. Published July 11, 2020. 
2. Goyal M, Singh N, Ospel J. Clinical trials in stroke in 2022: New answers and questions. The Lancet Neurology. https://doi.org/10.1016/S1474-4422(22)00488-4. Published January 1, 2023.
3. Stroke signs and symptoms. Centers for Disease Control and Prevention. https://www.cdc.gov/stroke/signs_symptoms.htm#:~:text=Sudden%20numbness%20or%20weakness%20in,balance%2C%20or%20lack%20of%20coordination. Published May 4, 2022. Accessed January 2023. 
4. Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. Bull World Health Organ. 2016;94(9):634-634A. doi:10.2471/BLT.16.181636
5. Phan K, Dmytriw AA, Maingard J, et al. Endovascular thrombectomy alone versus combined with intravenous thrombolysis. World Neurosurg. 2017;108:850-858.e2. doi:10.1016/j.wneu.2017.08.040