——" World Stroke Day" Series of Medical Science Popularization (1)
Lin Tian, Liu Li, Strategic Support Force Special Medical Center (formerly 306 Hospital), Department of Neurology
Edited by Liu Yan/Cui Yan, Medical Science Popularization Center, Ministry of Medical Research
October 29, 2021 is the 16th World Stroke Day, the theme of the campaign is "Be vigilant about stroke symptoms, identify and treat them as soon as possible", and the slogan is "Recognize stroke one second earlier, save the brain and recover well". In order to effectively prevent and control the high risk factors of stroke, improve the ability of the masses to recognize stroke, and reduce the death and disability caused by stroke, the Department of Neurology of the Special Medical Center of the Strategic Support Force and experts from the Department of Neurosurgery, Rehabilitation Medicine and Physiotherapy have written a series of stroke sciences, aiming to let more people know the importance of stroke prevention and treatment, so that people can use fragmented time in fast-paced life to understand stroke-related knowledge more quickly and effectively through popular science articles.
Cerebral infarction, also known as ischemic stroke, is an acute onset and severe symptoms, and is one of the important killers that threaten human life and disability. The cerebral arteries are like highways that transport nutrients to the brain, and the accumulation of waste on the road (atherosclerosis blocks the inner wall of blood vessels) and the occupation of roads by "road bullies" (embolus stuck in blood vessels) will lead to traffic jams, so that nutrients cannot be transported to specific locations in the brain on time, and brain tissue that does not receive nutrient supply will be deprived of oxygen and necrosis, and the functions it undertakes will be lost.
During cerebral infarction, every 1 minute of occlusion of the artery leads to the death of 1.9 million neurons; if the artery is occluded for more than 10 hours, it is equivalent to the number of neurons expected to disappear during the normal aging process of 26 years and is non-renewable. Therefore, "time is the brain", the treatment of cerebral infarction must race against the clock, one minute earlier treatment, can save a large number of dying neurons, the probability of recovery will be greatly improved.
The primary goal of acute cerebral infarction treatment is to relieve arterial blockage as soon as possible and restore blood flow to the brain, thereby reducing brain tissue damage and improving nerve function. At present, the most effective treatment is vascular recanalization within the time window, including intravenous thrombolysis and arterial thrombolysis, and the success rate of treatment is closely related to the time of onset.
Intravenous thrombolysis is one of the most effective pharmacotherapeutic measures to improve the outcome of acute cerebral infarction and has been recommended by our country and many national guidelines. Venous recombinant tissue plasminogen activator (rt-PA) is currently the most effective intravenous thrombolytic drug, required to be carried out within 4.5 hours of onset (the best time is less than 3 hours), the drug is injected from the vein, with the blood flow throughout the body, can make the fibrin in the thrombus dissolved, so that the blocked blood vessels are re-passed before the necrosis of ischemic brain tissue, saving ischemic brain tissue, and improving the prognosis of patients. The rate of intravenous thrombolytic vascular recanalization is about 20% to 40%.
Although intravenous thrombolysis has the advantages of simplicity and time-saving, the treatment time window is narrow and the recanection rate of large blood vessel occlusion of the head and neck is low. As an emerging treatment method of cerebral infarction, arterial embolectomy is to use a special stent to pull the thrombus out of the blocked blood vessel, or use a special suction catheter to pull the thrombus out, so that the blocked blood vessel can be quickly re-passed, and the success rate of arterial embolism is about 50% to 90%. The treatment time window of emergency arterial embolectomy is usually 6 hours after the onset of the disease, and can also be extended to 16 to 24 hours after the onset of the disease according to the patient's brain tissue condition, which is longer than the time window of intravenous thrombolytic therapy, which is more suitable for patients with large vascular occlusion, which is not only one of the alternative treatment options for intravenous thrombolysis, but also a remedial choice for patients with contraindications to intravenous thrombolysis.
Map of prognosis after intravenous thrombolysis
The stent is throbbed
Remove the blood clot
Time is the brain, time is life. The treatment of cerebral infarction patients is a race against time, and every minute saved from discovery to treatment will become a guarantee for a good prognosis of patients. Only by accurately and timely identifying stroke can we have the opportunity to receive timely treatment and minimize the harm of the disease.
To this end, China has introduced a rapid recognition method for acute stroke suitable for Chinese people, that is, "stroke 120": 1 represents seeing an asymmetrical face; 2 represents unilateral weakness in both arms; 0 represents (listening) and finds that speech is unclear. If one of the above conditions is a suspicious stroke, you should immediately call the emergency number 120, or quickly go to a nearby hospital with stroke treatment capacity, never stay at home for your own observation, and do not repeatedly consult with relatives and friends, missing the best time for treatment.
(Pictured from the Internet)