62 y.o. lady had sudden onset of paralysis of left side of the body with difficulty in speech. She was immediately bought to the Medanta, The Medicity hospital where she was found to be suffering from acute stroke leading to complete left side paralysis. His immediate CT revealed that found that her major blood vessel in brain was occluded which was causing damage to her brain. Specialized imaging (CT based brain blood flow imaging) revealed that although some tissue was already dead, there was significant part of his brain which could still be revived by restoring the blood supply. However if this was not done soon, those brain cells were likely to die in very short while. She was treated by intra-arterial thrombolysis. Through the leg artery a very small tube (microcatheter) was placed in the blocked brain vessel and clot dissolving drugs were given to open it up. She started to recover immediately and was completely all right in next 24 hours. She has now recovered complete power in left arm and leg with no difficulty in speech and living a normal life.
Patients with acute ischaemic stroke or paralytic attacks usually face a life of dependancy with a huge psychological, social and financial burden. Acute stroke happens due to blockage of blood supply. Although some brain cells die immediately, there is usually a part of brain which can still be revived if the blood supply is restored in next few hours. This can be done by giving thrombolytic drugs (Intravenous thrombolysis) which act as clot busters and open up the blockage in the arteries. This can result in reversal of stroke and better recovery. Direct delivery of drugs in the blocked artery (Intra-arterial or endovascular) therapy can be more effective when clot is large or when IV therapy cannot be given. This is done by placing a catheter (a small tube) from one of the leg blood vessels in to the blocked vessel followed by injection of blockage (clot) dissolving drugs. Many mechanical devices are also available which can be used to extract clot from the brain to open the blood vessel. This selective (intra-arterial) treatment can be given at least up to 8-hours after the brain attack. First such case of mechanical recnalization using penumbra device in North India was done in Medanta, The Medicity. Recently first case of direct stenting to open up a blocked vessel was performed in the hospital. All patients of stroke are immediately assessed with CT angiography and perfusion (brain blood flow) imaging using 256 slice CT scan to detect patients which have brain which can be revived and can benefit with immediate treatment. We are the only centre in North India to use such technology as a part of protocol.
Patient a 43 year old male working in an insurance company suddenly became unconscious at work. He was taken to a nearby hospital which revealed brain haemorrhage. He was shifted to Medanta, The Medicity. Brain Angiography revealed a swollen blood vessel (aneurysm) which had burst to cause the bleeding. He was at high risk of repeat haemorrhage and immediate repair of the leaking blood vessel was needed to safe his life. This procedure was done by endovascular means through his leg blood vessel. A very small tube (microcatheter) was placed in to the swollen damaged blood vessel and the bleeding point was closed using platinum coils (coiling). Patient has made almost complete recovery and has gone back to his routine life.
Aneurysms are focal swelling of blood vessels, which can burst and cause bleeding in brain. It is accepted that about 3% to 5% of the population harbour an intracranial aneurysm and one in every 20 strokes is caused by rupture of intracranial aneurysm. The aneurysm disease commonly strikes at prime of one's life at age of 40-50 yrs. Although it is less common then some other forms of stroke, because the disease strikes a fairly young age and is often fatal the loss of productive life years is similar to that for cerebral infarction or intracerebral hemorrhage. Many patients (up to 30%) do not survive initial bleeding. Even the patients who survive more than 50% of patients do not survive even for a month because the aneurysm bleeds again. Even the patients who survive the initial bleeding, more than 50% of patients do not survive even for a month because the aneurysm bleeds again. Open surgery "clipping" has been the conventional method of aneurysm treatment but has high chances of trauma to normal brain parenchyma. By endovascular method a microcatheter (a very thin tube) is placed into the brain aneurysms through the leg blood vessel. Then the aneurysm is occluded by using specialized coils. This procedure known as "coiling" has advantage of minimal injury to normal brain and leading to better outcomes. Studies have shown that patient recovery is much better with coiling rather than clipping. Medanta The Medicity has developed a dedicated brain aneurysm program and more than 90% of brain aneurysms are treated by endovascular means with very good clinical outcomes.