Unicamp's Hospital de Clínicas successfully performed its first cerebral catheterization treatment (thrombectomy) on a stroke patient. The 40-year-old patient suffered an ischemic stroke while working and was referred to emergency care at the HC. As the thrombolytic treatment, which unblocks cerebral circulation, did not resolve the issue, the medical team decided on the cerebral catheterization procedure. The patient is doing well and should be discharged in the next few days without any sequelae.
At Unicamp's HC Referred Emergency Room, an average of 90 patients are treated per month. In Brazil, every 5 minutes a person dies from a stroke, being the second cause of death and the first cause of disability in the country, according to the Associação Brasil AVC (ABAVC). Every year around the world, 17 million people have a stroke, 6,5 million die and 26 million live with permanent disability. As it is the main cause of disability, stroke needs to be identified and treated quickly so that the patient has fewer consequences.
The medical team from the HC of Unicamp and the Faculty of Medical Sciences (FCM), together with 25 other centers in Brazil, is part of the “Resilient” clinical study of the Ministry of Health. This committee intends to evaluate 600 patients across the country, victims of Ischemic stroke within the first six hours of the onset of symptoms (hyperacute phase). The aim is to use minimally invasive procedures that reduce the risk of sequelae in patients, such as the one carried out at HC last week.
According to HC's interventional neurologist, Fabricio Buchdid Cardoso, responsible for the patient's care and procedure, thrombolytic treatment, which unblocks cerebral circulation when used within 4,5 hours of the onset of symptoms, increases the chances by up to 30 %. “This treatment by cerebral catheterization, when used within eight hours, increases the chances by more than 50% and in the case of our patient the chance was 90%”, celebrates Cardoso.
For neurologist Wagner Mauad Avelar, responsible for the stroke clinic, help must be quick precisely to prevent the affected area of the brain from remaining for a long time without being irrigated. When this happens, the tissue becomes necrotic, which prevents its recovery. “In other words, time is brain,” he says. The biggest concern is the occurrence of hemorrhage, an ischemic stroke can become hemorrhagic when a necrotic vessel ruptures and causes hemorrhage within the ischemia.
The Ministry of Health’s “Resilient” clinical study aims to prove at a national level what is already known in international studies. “This type of neurointervention procedure for ischemic stroke has great benefits, mainly in reducing disability and sequelae, and also in reducing costs with ICU hospitalization, antibiotics and physiotherapy”, comments the professor of the Department of Neurology at FCM, Li Li Min.
According to doctors, this procedure is not part of the HC's routine care until the Ministry of Health completes the “Resilient” project and proves the feasibility and cost-effectiveness of mechanical thrombectomy in Brazil. Neurologists reinforce that the success of the technique depends on good collateral flow, that is, that other arteries are carrying blood to the area of the brain affected by the stroke.
Stroke - Experts recommend some procedures that pay attention to symptoms. Raise the arms and legs to detect weakness, smile to see if there is a shift in phase, and speak to check for changes in language. The main symptoms and warning signs include paralysis (difficulty or inability to move); very strong, sudden headache, especially if accompanied by vomiting; weakness or numbness in the face, arms or legs, usually one side of the body is affected; sudden loss of speech or difficulty communicating and understanding what is said and loss of vision or difficulty seeing with one or both eyes.
Other symptoms of ischemic stroke are dizziness, loss of balance or coordination. Ischemic attacks can also manifest with changes in memory and the ability to plan daily activities, as well as negligence. In this case, the patient ignores objects placed on the affected side, tending to divert visual and auditory attention to the normal side, to the detriment of the affected side.
Symptoms of intracerebral hemorrhagic stroke may include nausea, vomiting, mental confusion and even loss of consciousness. Subarachnoid hemorrhagic stroke, in turn, is commonly accompanied by drowsiness, changes in heartbeat and respiratory rate and eventually convulsions.
Caius Lucilius With Juliana Castro
HC Unicamp Press Office
