Treating Ischemic Stroke: Thrombectomy to Save Lives

For stroke patients, every second counts, and immediate medical intervention is essential. In cases of acute ischemic stroke, performing an arterial thrombectomy within six hours of onset can significantly improve recovery prospects and help patients regain independence.

The brain depends on a constant blood supply for the oxygen and nutrients it needs to survive. Arteries transport oxygenated blood from the heart and lungs to various parts of the brain. When one of these arteries is blocked, a stroke may occur. A stroke can also be caused by a weakened blood vessel wall that stretches and eventually ruptures. In either case, the result is reduced oxygen flow to the brain, leading to cell damage or death. This affects the areas of the body controlled by those brain cells, often causing functional impairment or even disability.

There are two main types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke, the more common type, occurs when a blood clot or other blockage obstructs a blood vessel in the brain. Hemorrhagic stroke, on the other hand, results from a blood vessel rupture causing bleeding in the brain. Dr. Mohd Fariq bin Mohd Yusof, a radiologist and interventional radiologist at Assunta Hospital, notes that some patients or their families may not recognize the severity of a stroke, sometimes delaying treatment by a day or two after symptoms begin. However, this delay can lead to irreversible damage because oxygen deprivation can cause brain tissue to die over time.

Brain tissue controls crucial bodily functions. If a stroke impacts the language center, it can lead to speech impairment and memory loss. If the motor control area is affected, it may cause partial paralysis, difficulty walking, and other lasting effects, severely impacting the patient’s ability to live independently. This can place a heavy caregiving and financial burden on families.

Since stroke is an emergency, Dr. Fariq urges the public, especially high-risk individuals, to remember the acronym “BEFAST” to identify early stroke symptoms. If even one of these symptoms appears, immediate medical care is crucial.

Treating Ischemic Stroke

When a stroke patient arrives at the hospital, a CT scan is performed to assess the severity and determine whether the stroke is hemorrhagic or ischemic. Time is of the essence in administering clot-dissolving drugs or performing a thrombectomy.

Dr. Fariq explains that, traditionally, patients with acute ischemic stroke needed to receive clot-dissolving medication within four hours of onset to dissolve the clot and restore blood flow. After treatment, patients are usually closely monitored for two to three days, observing their condition and assessing brain blood flow.

Over the past decade, arterial thrombectomy has emerged as a cutting-edge treatment for acute ischemic stroke. This minimally invasive technique involves inserting a microguidewire and microcatheter through an artery in the patient’s groin or wrist, which is then guided under X-ray to the blocked artery in the brain. Once the microguidewire and microcatheter reach the blockage, a stent is placed at the clot site to simultaneously aspirate and clear the clot, restoring blood flow. The procedure typically takes about an hour, allowing patients to resume eating, speaking, and walking as soon as the following day. Most patients are able to be discharged within three to four days.

Arterial thrombectomy, performed under local anesthesia, involves only a small incision (about 0.5–1 cm), allowing patients to return to daily activities quickly. This procedure aims to promptly restore blood supply to ischemic tissue, minimizing the extent of damage and reducing the risk of post-stroke complications. Unlike traditional surgery, thrombectomy does not require general anesthesia or opening the skull, which helps alleviate patients’ anxiety, especially among the elderly. Additionally, clot-dissolving drugs carry a risk of acute brain bleeding.

Lifestyle Changes to Lower Stroke Risk

According to statistics, stroke was Malaysia’s third leading cause of death in 2023 and is projected to become the second leading cause by 2040. Currently, 150 out of every 100,000 Malaysians are at risk of stroke, and the number of cases continues to rise.

Dr. Fariq stresses the importance of lifestyle modifications for both high-risk individuals and those who have experienced a stroke. Quitting smoking and alcohol, managing weight and stress, following a balanced diet, exercising regularly, and improving sleep can help keep blood pressure, cholesterol, and weight at healthy levels, reducing stroke risk.

BEFAST Symptoms of Stroke:

• B (Balance): Sudden loss of balance or coordination.
• E (Eyes): Sudden vision loss in one or both eyes, or double vision.
• F (Face): Ask the person to smile; check if one side of the face droops.
• A (Arms): Ask the person to raise both arms; see if one arm drifts downward.
• S (Speech): Ask the person to repeat a sentence; listen for slurred or strange speech.
• T (Time): Act fast; every second counts.

MANDARIN

治缺血性中风
脑部取栓拯救生命

中风患者在发病时，分秒必争地送医抢救极为重要。急性缺血性中风在发病后，在6小时内进行介入动脉取栓手术，及时接受治疗以提高康复机会，帮助患者恢复到独立生活。

大脑依赖血液持续供应，以获取生存所需的氧气和营养。动脉这类管状血管将含氧血液从心脏和肺部输送至大脑各个部位；当其中一条动脉血流受阻时，便可能发生中风。
此外，当血管壁某处变弱、拉伸并最终破裂时，也可能引发中风。不论是哪种情况，中风都会使大脑缺氧，导致脑细胞受损或死亡，进而使这些细胞所控制的身体部位出现功能障碍，甚至残疾。
中风分为缺血性脑中风及出血性脑中风，其中以脑血管被血栓、血块堵塞，造成血液无法流通，导致缺血性脑中风（Ischemic）较为常见，另一种是脑血管破裂，造成脑出血属于出血性中风（Haemorrhagic）。
亚松大医院放射科兼介入放射科莫哈末法里克医生表示，部分患者或家属未意识到中风的危险性，病发一两天后才到医院求医。殊不知拖延就医时间，造成不可逆的后遗症，因为脑血管被血栓堵住会造成脑部缺氧，而脑部组织会因为长时间供氧不足而坏死。
大脑组织控制着人体的重要机能，一旦坏死区域位于语言区，便可能导致语言障碍和记忆丧失；若影响到运动控制区，则可能引发肢体偏瘫、行走困难等后遗症，严重影响患者日后的生活自理能力或长期卧床。此外，患者家属需长期照护，承受重大的经济负担和照护压力。
基于中风是突发疾病，因此他呼吁广大民众及高危险群的家属需牢记中风的口诀“BEFAST”，辨识中风初期的重要症状。只要察觉到其中一项症状出现，必须将患者尽快送往医院，把握抢救黄金时间。

抢救缺血性脑中风

当患者送达医院将立即进行 CT 扫描，以评估严重程度并确认是出血还是缺血性中风。可以争取时间施打血栓溶解药物或是动脉取出血栓。
莫哈末法里克医生分享，以往，急性缺血性中风患者需在发病后尽快送往医院施打血栓溶解剂，以疏通堵塞血管和溶解血栓，于病发后的4小时内进行较为理想。治疗完成后，患者通常需接受两至三天的密切观察，监测病情及生命体征，并评估脑部血流的恢复情况。
他指出，近十年来，动脉取栓术已成为治疗急性缺血性脑中风的先进方法。此技术利用微创脑导管，医生通过患者的鼠蹊部或手腕动脉插入微导丝和微导管，并在透视（X 射线技术）引导下将其导向大脑堵塞的动脉。
微导丝和微导管通过动脉阻塞处后，医生会在血栓位置放置支架，并同时进行抽吸和清除血栓，直到血管恢复血流。手术大约需一小时，患者通常在术后一天即可恢复进食、说话和行走等正常活动，3至4天后便可出院。
动脉取栓术是一种微创手术，手术伤口仅约0.5至1公分大小，仅需局部麻醉，患者能在短时间内恢复日常生活。该手术旨在即时治疗患者，使缺血组织尽快恢复血液供应，从而减少缺血坏死范围，降低中风后遗症的风险。
与传统外科手术相比，动脉取栓术无需全身麻醉或打开颅骨进行脑部手术，有助于缓解患者对手术的焦虑，对于年长患者也是一个好消息。此外，使用血栓溶解剂可能增加急性脑出血的风险。

改变习惯 远离风险

根据统计局数据显示，中风在2023年是马来西亚的第三大死亡杀手，预计到了2040年将成为第二号杀手。目前，每10万名大马人当中，有150人被鉴定面对中风的风险，中风患者的人数每年都在增加。
莫哈末法里克医生提醒，无论是高风险人士或曾经接受治疗的中风患者，在日常生活需要注重健康问题的根源。保持决心改善不良生活习惯，如戒烟、戒酒、管理体重、管理压力、均衡饮食、保持规律运动及改善睡眠呼吸中止症等，以让血压、血脂、胆固醇及体重处在健康水平，避免诱发中风。

图说：

缺血性脑中风
出血性脑中风

BEFAST

B（BALANCE）
身体或步态突然不平衡。

E（EYES）
突然单眼或双眼失明，或是出现复视。

F（FACE）
请患者微笑或是观察患者的脸部表情，两边的脸是否对称。

A（ARMS）
请患者将双手抬高平举，观察其中一只手是否会无力下垂。

S（SPEECH）
请患者读一句话，观察是否清晰且完整。

T（TIME）
时间

莫哈末法里克医生讲解缺血性中风是如何在脑血管中形成血栓。

莫哈末法里克医生：中风患者需要在短时间内获取治疗，否则有机会丧失身体功能，甚至危及性命。

亚松大医院放射科兼介入放射科
莫哈末法里克医生 Dr Mohd Fariq bin Mohd Yusof