[Smart Doctor] The Key to Stroke Treatment is ‘Time’. ⏳ | Stroke Part 2

Q. How is a stroke treated?

First, let’s look at the common ‘stroke’ where a blood vessel gets blocked. We call this a ‘cerebral infarction’ or an ‘ischemic stroke,’ and these cases are much more frequent. Currently in Korea, about 70% of strokes are caused by blockages, while about 15% are caused by blood vessels bursting. Because hemorrhagic strokes (bursting) are generally more dangerous, people used to think of strokes as a fatal or severe disease, but risk factors have changed significantly. In particular, proper management of blood pressure has relatively reduced the incidence of hemorrhagic strokes. First, we perform tests to determine whether there is a blockage or a rupture in the brain.

We start by taking a CT scan. On a CT scan, the blocked area only begins to turn black after 12 to 24 hours have passed, but treatment must be administered quickly within a few hours. Therefore, even if we take a CT scan immediately, nothing may show up. Nevertheless, a CT is helpful. This is because a rupture appears white, and we take the scan to check for that. If it is a rupture, we treat it accordingly. For blockages, if the patient arrives within 4.5 hours, there is medication to open the blocked vessel. Since a blood clot is the cause, there is medicine to dissolve the clotted blood. This is called a ‘thrombolytic agent.’ While there are various drugs, the only one practically used is ‘TPA.’ So, you only need to know ‘TPA.’ If a patient arrives at the emergency room with sudden paralysis and is quickly given TPA via injection, the drug can dissolve the blockage as it travels through the system, making it a vital basic treatment method. However, there are cases where the vessel does not open even after administering it. This can happen if the patient arrives late, but it can also fail even if they arrive early. This occurs when a very large clot is blocking the vessel.

If it’s a small blockage, it can be completely dissolved, but if it’s a large one, administering medicine through a vein may not be enough to reach and dissolve the entire clot. If only about one-third is dissolved, the remaining two-thirds stay blocked. Naturally, the effect will be minimal! Since the condition could worsen, if it is confirmed that the vessel remains blocked, we must use another method. That is ‘thrombectomy.’ A needle is inserted through the groin and a tube is threaded up into the body to the site of the blockage. There is a device designed to firmly grab the clot. We catch it and pull it straight out of the body. TPA has, of course, already been administered. By performing an additional ‘thrombectomy,’ blood flow is restored, and the patient improves. So, first, let’s use the thrombolytic ‘TPA.’ If that doesn’t work, let’s perform a ‘thrombectomy.’ This must be done within 24 hours! We must keep the possibility of both treatments open for you to get better, so it is extremely important to treat it this way, and I want to emphasize that you must also actively participate in this treatment process.

Q. What are the prevention methods after stroke treatment?

If a stroke has occurred, early treatment is vital, and preventing it from happening again is equally important. Even if the initial treatment was successful, high blood pressure and diabetes must be managed strictly. Additionally, for people with cardiac arrhythmia, a blood clot can break off from the heart and travel to the brain, causing a stroke. Such individuals must continuously take medication to prevent clots from forming in the heart. People with damaged blood vessels must also take medication to prevent further clot formation. The most famous one is ‘Aspirin.’ However, since Aspirin works by slightly thinning the blood and preventing platelets from clumping, it does have side effects. Nevertheless, because someone who has already suffered a stroke due to damaged cerebral vessels has a higher risk of recurrence than the average person, we use Aspirin despite those minor side effects. The benefits outweigh the risks.

By continuing to use such medications, we prevent further issues in the blood vessels. The same applies to patients with heart issues; they must use preventive medication to avoid a stroke. It is important for the patient and doctor to communicate continuously to ensure a stroke never happens again.

Manage through continuous communication between patient and doctor to prevent recurrence!

Recognizing a stroke is important, but what matters most are the risk factors I mentioned. You should avoid these from a young age to live a long, healthy life without strokes. You are always welcome to visit the neurology clinic to consult with us. We will provide prevention guidelines tailored to you so that we can work together to prevent strokes in your daily life. I emphasize these two points. I will do my best to help you. Thank you.