New Era for Stroke Treatment
By Dr. Rashid M. Janjua
Until about 15 years ago, there wasn’t much we could do about a stroke except treat the symptoms.
The first breakthrough came in 1997 with the approval of clot busting drugs for use in stroke patients. The drugs work wonders, but they don’t work in all cases and or for all kinds of stroke.
Today, new surgical interventions allow neurosurgeons like me to treat all kinds of strokes by removing blood clots and closing off aneurysms. I am one of the few neurosurgeons in the country trained in the full scope of these techniques, and the only one in the Triad, which means that I have the opportunity to prevent crippling disabilities in my patients at Wake Forest Baptist Medical Center. I am thrilled to bring these techniques to North Carolina, a part of the country known as the Stroke Belt, where treating stroke is so urgently needed.
Nationally, stroke remains the third-leading cause of death, after heart disease and cancer. Just as significant to many elderly people and their families, it’s a leading cause of permanent disability. According to the Centers for Disease Control and Prevention, someone in the United States has a stroke every 40 seconds. The numbers add up. About 795,000 people have a stroke each year; 185,000 of them will suffer a second stroke. About 4.7 million people in the U.S. are stroke survivors. Finally, someone dies of a stroke every three to four minutes.
The figures are even worse here in North Carolina. For reasons no one fully understands, the incidence of stroke is higher in North Carolina and seven other southern states than in any other part of the country. In the U.S., the death rate from stroke is about 49 deaths per 100,000 of population. The rate in North Carolina is 54, and in some counties, such as Stokes County the rate is even higher, between 74 and 104 deaths per 100,000 people.
Strokes fall into two categories. Most strokes are caused by clots that block blood flow to the brain. These are known as ischemic strokes. Bleeding inside the brain causes the remainder of strokes. Clot busters work on ischemic strokes by restoring blood flow, but the drugs work in only 30 percent of the cases, at best. That’s when a neurosurgeon can help. In the past ten years, techniques first used by cardiologists to remove clots headed for the heart have been modified to do the same with clots headed for the brain. In some cases the neurosurgeon will insert a probe through a blood vessel in the groin to grab a clot headed for the brain.
In many hospitals, neurosurgeons perform one operation and other specialists the other. I’m trained in both, which means that I can adjust my treatment plan as needed – even in the operating room – and provide my patients with all the options available, not just one. I’m also trained to treat strokes caused by bleeding, usually when an aneurysm bursts. An aneurysm looks like a blister on an artery. In surgery, we can close off the blister with a metal clip or treat it with minimally invasive methods by going through blood vessels in the patient’s groin with a probe and plugging the aneurysm with platinum coils. When I’m done, all the patient sees is a band-aid covering the incision in the groin. The patients benefit from this because they get to choose the option that suits them best.
Neurosurgeons have also developed procedures that can prevent stroke. Sometimes clogged arteries in the neck can be a source of blood clots that travel upstream to the brain. We can open up this narrowed carotid artery by surgically scraping away plaque. There is also a less invasive procedure that requires only a small incision in the groin. We can guide a so-called “stent” into the carotid artery and use it to open the artery. Both types of carotid artery interventions have their benefits and risks. I give my patients the choice between the two treatments. In some patients, neurosurgeons with my training can supply new blood vessels to the brain to improve blood supply and with that brain function, a procedure called “Bypass surgery.”
My colleagues here at Wake Forest Baptist have been working on treating stroke for a long time. We’ve set up alliances with community hospitals in Lexington and in Ashe, Allegheny and Wilkes counties to help evaluate patients. Some patients can be treated in their community hospitals, but many cannot. They need the medical and surgical service provided by a large medical center. I came here several months ago to bring the most up-to-date surgical and minimally invasive techniques to people here in the Stroke Belt.
I’m well trained at removing clots and sealing off aneurysms safely. However, my skills won’t help much until more people know the signs of stroke; fewer than 10 percent of people who have a stroke get to an emergency room in time. For treatment with clot busting drugs we need you in the emergency room and treated within four and a half hours after your symptoms start; for those who do not make it in time, I can still help if you are in my hospital within eight hours of the start of the stroke.
Learn the signs of stroke: any slackness in the face, weakness or tingling in the arms, blurred vision or slurred and disorganized speech are all signs of a stroke. If you or someone close to you is having these symptoms, call 911 and get to the nearest emergency room.
Remember, the longer the stroke lasts, the more brain tissue is lost: time is brain!
Dr. Rashid M. Janjua is an associate professor of neurosurgery and radiology and the director of the Interventional Stroke Program at Wake Forest Baptist Medical Center.