Acute Stroke Treatment

Ischaemic Stroke

Acute Ischaemic Stroke (AIS) accounts for about 70% of stroke cases in Hong Kong. Though its presenting symptoms are not as serious as haemorrhagic stroke, its acute treatments demand a much more urgent time-frame. Being a serious medical emergency, rapid intervention for acute ischemic stroke is crucial. With right treatments performed within Golden-8-Hours to unblocked the brain arteries, ischemic brain cells can be revascularized. Thus the degree of brain cells damage can be minimized and patients has a higher chance of being cured and enjoy full recovery. Thus a short time to treatment is absolutely critical to increase the probability of a good recovery. Some stroke survivors even live like a normal person without suffering from any permanent neurological disability. 

Stroke Hotline and Allied Hospitals

 

HKBSSP provides comprehensive emergency stroke care services 24 hours a day, 7 days a week. Our Stroke Neurosurgeons, our Stroke nurses work with a team of specially trained medical practitioners under standardised protocols to optimize the management of acute stroke care. Once our Stroke Hotline being activated, our centre manages the logistics of emergency on-site clinical assessment, inter-hospitals transferral, hospital admission, quick medical imaging, timely diagnosis and treatments, and subsequent stroke rehabilitation services. 

By enabling a fast and efficient response, smooth communication and logistics, patients are able to receive timely evaluation and diagnosis, immediate organized treatment within the critical therapeutic time frame.  

The Deficiency of the Old Golden-3 to 4.5-Hours Regimen

The traditional treatment for acute ischemic stroke (AIS), the Golden-3 to 4.5- Hours Regimen, is the injection of recombinant tissue plasminogen activator (iv rtPA or ‘Activase’) within 3 to 4.5 hours after symptoms onset. However, more than 95% of the AIS patients do not benefit from this due to late presentations to emergency room, or delayed diagnosis, or patients falling into the exclusion criteria of iv rtPA. Furthermore, recombinant tissue plasminogen activator iv rtPA (The Golden-3 Hours Regimen) may not work efficiently for some strokes caused by large vessel occlusions, by long segment blood clots occlusion or by occlusive arterial dissection or injury.

A fine Catheter at Brain, Golden 8 Hours for Brain Revascularization

HKBSSP introduces the new ‘Golden 8 Hours’ concept for emergency treatments for acute ischemic stroke: minimally invasive endovascular procedure (namely Mechanical Thrombectomy) for Brain Revascularization, it precisely fills the gap and deficiency of The Old Golden-3 to 4.5- Hours Regimen of ivrtPA.

Patients can be treated within 8 hours after symptoms onset with minimally invasive endovascular procedure (namely Mechanical Thrombectomy) for Brain Revascularization. The minimally invasive treatment can salvage brain cells by breaking and aspiring the blood clot in the brain. Similar to cardiac percutaneous intervention (Cardiac PCI), Stroke Neurosurgeons will use a micro-catheter device that is passed through the vessels from the groin. Mechanical Thrombectomy treats at the exact point of clot, monitors with guidance of Cerebral Angiogram to ensure high accuracy in blood clot resolution.

Sometimes if there is an underlying diseased and narrowed brain artery that is causing the stroke, our Stroke Neurosurgeons will implant a soft metallic stent for reconstructing the brain artery.

Endovascular Mechanical Thrombectomy for Brain Revascularization.

Stroke can be Cured and Stroke Survivor can be a normal person:

Endovascular Mechanical Thrombectomy minimise the volume of damaged cells in the brain, which directly reduces the morbidity and mortality of ischaemic stroke. If being treated within Golden 3 to 8 Hours, all stroke symptoms may be reversible, patients may have a chance of being cured and enjoy full recovery. Some stroke survivors even live like a normal person without suffering from any permanent neurological disability s.

Extended to over Gold-24 Hours

For some posterior circulation ischemic strokes (vertebral-basilar thrombosis causing brainstem stroke) and for some patients with good cerebral collateral blood supply and blood flow , since their ischemic brain can withstand a much longer duration of blood deprivation, the Golden Hours Therapeutic Window can be even extended to beyond 24 hours.