Time is brain
1.9 million NEURONS die per minute in stroke
How does stroke occur?
Ischemic stroke results from suddenly blocked blood vessels. 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 continuous supply of oxygen. When a clot interrupts flow, neurons begin to die within minutes.
Urgent diagnosis and treatment are imperative for 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 is a blood clot?
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 is stroke treated today?
1.
Pre-hospital
assessment
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Rapid assessment: BE FAST
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Recognition of stroke type
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Transfer to nearest stroke centre
2.
Emergency Department
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Imaging and functional tests inform treatment
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Thrombolysis within ideal treatment window
3.
Inter-hospital transfer
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Some patients can require transfer to specialized stroke centres for endovascular therapy
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
