Timely dredging of "blocked rivers" allows brain tissue to "revive"

Cerebral stroke, commonly known as "brain infarction", is a group of acute cerebrovascular diseases with ischemic and hemorrhagic damage to brain tissue as the main clinical manifestations. Among them, ischemic stroke (also called cerebral infarction) is the most common, accounting for about 70-80% of strokes. It is caused by stenosis or occlusion of the cerebral blood supply arteries (carotid artery and vertebral artery), resulting in insufficient blood supply to the brain and causing brain tissue necrosis. According to data, about 2 million people die from stroke in my country each year, and 70% of the survivors are mostly left with disabilities such as hemiplegia and aphasia. The 5-year recurrence rate is above 40%, and ischemic stroke is still growing rapidly at a rate of 8.7% per year. Once a stroke occurs, it will bring great pain, mental and economic burden to the patient and the entire family.

Since the beginning of winter, the temperature in most parts of the country has dropped sharply, accompanied by a series of low-temperature cold waves, and the incidence of stroke has also shown a rapid upward trend. Professor Zhang Zhuobo, member of the Neurovascular Intervention Collaboration Group of the Chinese Medical Association's Neurology Branch, President of the Stroke Branch of the Heilongjiang Association of Integrated Traditional Chinese and Western Medicine, Director of the Department of Neurology and Director of the Stroke Center of the Fourth Affiliated Hospital of Harbin Medical University, reminded that severe cold weather not only creates snowflakes and sparkling frozen rain tree hangings, but also stroke patients taking advantage of the opportunity to cause chaos, which must be prevented.

Two cases: one old and one young

Mr. Li, 56 years old this year, is in good health and has no chronic diseases such as hypertension and diabetes. After finishing his meal one morning, he found that his right arm was a little out of control. He didn't care at first, but the symptoms gradually became more and more serious. Soon, he couldn't lift his right hand and right leg, and he didn't obey the command at all. At the same time, his speech was unclear. Seeing this, his family hurriedly sent him to the Department of Neurology of Harbin Medical University Fourth Hospital. Professor Zhang Zhuobo, the director of the department, quickly and in detail interviewed and examined the patient, and after an emergency head CT scan, he was initially diagnosed with "acute ischemic cerebrovascular disease". Because the patient had been ill for more than 8 hours when he was admitted to the hospital, he missed the best time for intravenous drug thrombolysis (the time from onset to intravenous thrombolysis was less than 4.5 hours). Professor Zhang made a prompt decision and immediately performed emergency whole brain angiography, confirming that Li's left middle cerebral artery was severely narrowed. During the operation, he was given thrombolytic drugs to "dredge" this important blood vessel again. Now, after being discharged from the hospital, Mr. Li has recovered well. The strength of his right limbs is almost the same as that of a normal person, and he has avoided the common post-stroke symptoms of "carrying a basket" and "using crutches".

It is not just the middle-aged and elderly who are vulnerable to stroke, but also the vigorous young people. Xiao Zhou, 35 years old this year, is a business manager of a logistics company. He is very busy with his business and often stays up late to work overtime. "5+2" and "day and night" are his daily portrayals. Since the beginning of winter this year, the young man has suddenly experienced "failure" of his right upper limb twice during online video conferences, which was relieved by himself a few minutes later. Because he has been working at his desk for many years, Manager Zhou thought it was caused by cervical spondylosis and ignored it. When the third symptom came, his right upper limb was almost completely immobile. Accompanied by his colleagues, Xiao Zhou immediately came to the hospital for treatment. After a head MRI examination, it was found that his left middle cerebral artery was moderately to severely narrowed. Combined with the patient's condition, Professor Zhang Zhuobo performed whole brain angiography for him. During the operation, balloon dilatation angioplasty was performed at the narrowed part of the artery to make the narrowed blood vessels unobstructed again. Zhou thus avoided the damage of acute ischemic cerebrovascular disease from the root.

Warning signs of cerebral infarction

Through the analysis of the two typical cases of an old man and a young child, Professor Zhang Zhuobo reminds everyone that when a stroke, especially an ischemic stroke, strikes quietly, the body will send out some warning signals, such as limb weakness, numbness, slurred speech, crooked mouth, ataxia, hemianopsia, etc. Some people may have whole-brain problems such as headache, vomiting, and coma. When the above abnormalities occur, be sure to be alert. Even if the symptoms are immediately and completely relieved, do not observe at home by yourself, but seek medical attention immediately; if the symptoms are severe, call 120 emergency number immediately and transfer to a medical institution with acute stroke treatment capabilities. Such hospitals usually have emergency green thrombolysis channels or regular stroke centers, which can optimize the process, win precious rescue opportunities, and ensure that acute stroke patients can reopen the "life channel" of blood vessels in the shortest time.

So, what is the cause of acute ischemic stroke? How to provide emergency rescue? Professor Zhang explained that acute ischemic stroke refers to thrombosis, embolus detachment or hemodynamic changes in cerebral arteries, which reduces the blood volume in the blood supply area and leads to ischemic necrosis of brain tissue. The key to emergency treatment is to open the occluded blood vessels as soon as possible, restore blood flow, and save the "ischemic penumbra". A large number of clinical studies have shown that intravenous thrombolysis within the "time window" is currently internationally recognized as an effective therapy for vascular recanalization. In 2019, the American Heart Association and the American Stroke Association guidelines updated the recommendations for intravenous thrombolysis for acute ischemic stroke, and recommended intravenous thrombolysis for patients within 3 hours and 3-4.5 hours of onset.

If the patient is admitted to the hospital after more than 4.5 hours of intravenous thrombolysis, or if the intravenous thrombolysis is ineffective, intravascular treatment can be given directly or after intravenous thrombolysis. Digital subtraction angiography (DSA) is the gold standard for diagnosing large vessel occlusion. For acute ischemic stroke patients who are initially evaluated to be very likely to be in large vessel occlusion, DSA examination can be performed directly in the emergency department on the basis of intravenous thrombolysis. During the operation, the occluded blood vessels can be quickly opened through arterial thrombolysis, mechanical thrombectomy, acute angioplasty (balloon angioplasty and stenting), etc. The earlier the treatment, the better the effect and the lower the risk of residual sequelae.

Resolve risk factors promptly

According to the results of epidemiological surveys on stroke in my country, the incidence of stroke in China is currently younger, with a higher proportion of males than females, and higher incidence in rural areas than in urban areas. In terms of geography, the incidence is higher in the north and lower in the south, and more prominent in the central region. At the same time, ischemic stroke has increased and hemorrhagic stroke has decreased. From the perspective of common risk factors for stroke, obesity, hypertension, diabetes, dyslipidemia, high homocysteine, unhealthy eating habits and lifestyles (such as high fat, high sugar, high salt, lack of exercise, smoking and alcohol abuse, etc.) are all the driving forces behind stroke, which is particularly serious in the Northeast. In addition, the people in the north are exposed to cold environments for a long time, and the blood vessels are contracted and narrow due to low temperature stimulation, which will "lack stamina" for blood supply to the heart and brain. At the same time, the high-latitude provinces are dry and windy in winter, and the indoor temperature is high. If the fluid is not replenished in time, it is easy to make the blood thick, increasing the probability of blood vessel blockage.

Director Zhang Zhuobo further explained that stroke risk factors are divided into two categories: non-interventional and interventional. The former mainly includes age, race, genetic factors, etc., which people cannot change; while the latter includes hypertension, diabetes, dyslipidemia, heart disease, diet, overweight, obesity, lack of physical activity and psychological factors, etc., which can be overcome through timely correction. Among them, controlling high blood pressure is an important part of effective stroke prevention. Zhang Zhuobo pointed out that, first of all, hypertensive patients must pay attention to adding or removing clothes in time according to temperature changes, and it is best to avoid suddenly exposing themselves to too low temperatures when going from warm indoors to outdoor activities. They should follow the principle of "gradual progress" and gradually adapt to temperature changes. Secondly, self-measurement of blood pressure at home is an important means of self-monitoring and self-management for hypertensive patients. Every patient with conditions should conduct home blood pressure monitoring and risk assessment, and cooperate with doctors to implement effective management. Third, elderly people over 65 years old should conduct health monitoring every year to prevent the sneak attack of cardiovascular and cerebrovascular diseases.

The latest research results from abroad show that the recurrence rate of ischemic stroke patients is 6.8% and the recurrence rate of hemorrhagic stroke patients is 0.7% within 3 months. Professor Zhang Zhuobo especially warned that patients who have received intravascular treatment must follow the doctor's advice to take oral antiplatelet or anticoagulant drugs and statins on time and have their blood vessels checked regularly to avoid another stroke.