1.9 million NEURONS die per minute in stroke
Time is brain
Time is brain
What causes a stroke?
Ischemic strokes result from a blockage that develops suddenly in blood vessels that supply the brain. These blockages can form when:
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Fatty deposits build up inside vessels
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Clots form in the heart and travel to the brain
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An acute injury (e.g. dissection) creates clots
The brain is a highly sensitive organ and requires a continuous supply of oxygen. When a clot interrupts blood flow, brain cells begin to die within minutes.
Timely diagnosis and urgent treatment are critical for the patient to have the best chance of functional recovery.
Recognizing stroke
Early recognition saves lives. The BE FAST method helps identify stroke symptoms:
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Balance – Sudden loss of balance
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Eyes – Sudden vision changes
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Face – Facial drooping
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Arms – Arm weakness
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Speech – Slurred or difficult speech
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Time – Call emergency services immediately
Stroke risk factors
Lifestyle Risk Factors
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Obesity or being overweight
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Physical inactivity
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Heavy alcohol use
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Smoking or secondhand smoke exposure
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Illegal drug use
Medical Risk Factors
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High blood pressure
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High cholesterol
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Diabetes
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Heart disease or irregular rhythm (a-fib)
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Obstructive sleep apnea
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Family history of stroke or heart attack
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COVID-19 infection
What are clots?
Blood clots differ in structure and composition:
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Fresh clots (rich in red blood cells)
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Mixed clots
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Organized clots (fibrin-rich)
Because clot type affects how well treatments work, modern stroke systems must be capable of handling multiple clot morphologies while minimizing the risk of clot fragments breaking off and causing further harm.
How are strokes treated?
Pre-hospital
assessment
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Assessment: BE FAST
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Recognition of stroke type (bleed vs. block)
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Stroke centre transfer
Emergency Department
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Imaging and functional tests inform treatment
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Thrombolysis within ideal treatment window
Inter-hospital transfer
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Some patients require transfer to specialized stroke centres for intervention
Treatment options
Thrombolysis
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Medications: Alteplase (tPA), Tenecteplase (TNK)
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Most effective when given early
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Limited by time windows and clot characteristics
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Efficacy decreases with time
Treatment options
Mechanical thrombectomy
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Minimally invasive procedure to physically remove clots
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Shown in major trials to significantly improve outcomes
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Uses specialized catheters, guidewires, and stent-based devices
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Increasingly the standard of care for large-vessel strokes
Treatment options
Who is eligible for thrombectomy?
Eligibility depends on:
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Patient age and demographics
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Baseline independence
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Functional deficit in patient
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Location of the occlusion
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Salvageable brain tissue on imaging
Treatment options
Effective treatment
Peri-operative:
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Restoration of blood flow to the brain
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Speed of reperfusion (faster is better)
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Number of device passes needed to remove the occlusion
Post-operative:
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Scores range from 0 (no symptoms) to 6 (death)
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Successful treatment aims for mRS 0–2, meaning independence in daily life
