Stroke therapy

Ischemic stroke is one of the three major causes of death and disability in our community. Ischemic stroke is caused by the blockage of an artery of the brain, generally by clot, leading to loss of blood supply. The brain is extremely dependent on a continuous blood supply, and generally its cells start to die as soon as blood supply is cut off. Some people may have more tolerance than others to an occluded blood supply, as they may have connections between different areas of the brain, however generally damage accumulates rapidly over minutes to hours, rather than days. Untreated, the damage commonly leads to permanent disability or commonly, death.

As recently as 2014, an operation performed by Interventional Neuroradiologists called “endovascular neurothrombectomy” or “endovascular clot retrieval” or “intracranial mechanical thrombectomy” was shown to be extremely effective in 6 randomized controlled trials, and was confirmed in meta-analyses (the two strongest forms of formal medical studies).

Endovascular neurothrombectomy is generally performed with the patient asleep, but occasionally for safety reasons is done with the patient awake. The arterial system is accessed at the top of the leg (femoral artery), or at the wrist (radial artery).

NIISwa performs all endovascular neurothrombectomies in Western Australia, allowing the expertise to be concentrated, and hence the operations to be performed as rapidly and as safe as possible. The importance of such centralisation has been proven in published studies, even taking into account the time needed to transfer patients to high-volume centres (Rinaldo L, Brinjikji W, Rabinstein A. Transfer to High-Volume Centers Associated With Reduced Mortality After Endovascular Treatment of Acute Stroke. Stroke 2017; 48: 1316-21).

Whilst this intervention represents one of the most effective therapies seen in the age of modern medical therapy, the operation cannot bring back brain that is already damaged. The operation is not without risk. Thus, the performance of this operation is decided on a case-by-case basis in consultation between a NIISwa Interventional Neuroradiologist and a Neurologist.