Stroke & Ischaemia

Thrombectomy in Stroke/Acute Stroke Intervention

A thrombectomy is a procedure that removes blood clots from a large artery in the brain using special tubes (catheters) and devices. This procedure aims to restore normal brain blood flow and reduce damage to brain tissue. 

    • Weakness or numbness (face, arm, or leg and usually confined to one side)

    • Difficulty speaking or understanding speech

    • Loss of vision

    • Headache

    • Difficulty walking, dizziness or loss of balance

    FAST is useful to describe stroke presentation and includes Face drooping, Arm weakness, Speech problems, Time to call 000 (in Australia)

    • Urgent testing is needed in an emergency department

    • CT and MRI are used to show the type and location of the stroke and the amount of brain tissue at risk

    • CT angiography or MR angiography – provides detailed blood vessel imaging of the brain and neck to look for the location of the blocked artery

    • Only certain patients are eligible for a thrombectomy and it depends on the time from onset of symptoms, type of stroke, degree of burden and the patient’s baseline condition

    • Treatment can only be performed in a specialised hospital with a team trained in neurointerventional radiology techniques

    • A small tube (catheter) is inserted into an artery in the groin or wrist and guided to the site of blockage within the brain using x-rays

    • A device (stent retriever or suction catheter) is used to engage and remove the blood clot

    • Treatment may be combined with clot-busting medications in some cases

Dr Andrew Gauden Melbourne neurosurgeon acute stroke intervention

Carotid Stenosis

Carotid stenosis is the narrowing of the carotid arteries, the main artery that supplies blood to the brain. This is caused by deposits of fatty tissue forming plaque.

Narrowing of the artery can increase the risk of stroke.

  • Some patients can have no symptoms (asymptomatic)

    Others may present with transient ischaemic attacks (TIAs) with symptoms such as:

    • Sudden weakness or numbness of face, arm or leg along one side

    • Difficulty speaking or understanding speech

    • Loss of vision

    • Headache

    • Difficulty walking, dizziness or loss of balance

  • Based on scans such as

    • CT or MR angiography

    • Ultrasound of the neck

    • In some cases, an angiogram may be needed

  • Medical management

    • Is used in patients with mild narrowing

    • Will require treatment with medications including cholesterol and blood pressure tablets and blood thinners

    • Lifestyle changes may be required

    Treatment with a procedure may be required to reduce the chance of a stroke

    Carotid stenting

    • A minimally invasive treatment

    • A small tube (catheter) is inserted into the artery from the groin or wrist

    • A metal tube (stent) is placed to keep the artery open

    • A balloon may be needed to inflate across the narrowed artery to widen it (angioplasty)

    • Stenting may need additional treatment with blood thinning medications

    Hospital stay is shorter – often only an overnight stay is required and a quick recovery

    Carotid endarterectomy

    • A surgical procedure of the neck

    • Usually performed with general anaesthetic

    • The neck is cut open to expose the artery

    • The artery is opened and the plaque narrowing the vessel is removed

    • The artery is then repaired with a patch and normal blood flow is restored

    • Hospital stay is longer – often up to 3 days with a longer recovery period of a few weeks

Dr Andrew Gauden Melbourne neurosurgeon carotid disease

Intracranial atherosclerotic disease (ICAD)

Intracranial atherosclerotic disease occurs when the brain blood vessels become narrowed or blocked up due to the presence of fatty deposits or plaque within the artery walls. This can reduce the blood flow to parts of the brain and increases the risk of a stroke. This is more commonly seen in patients with high blood pressure, diabetes, high cholesterol and in patients who smoke.

    • ICAD may be asymptomatic unless the blood flow is significantly reduced

    • Other symptoms include:

      • Sudden weakness or numbness in the face, arm or leg

      • Difficulty speaking or understanding speech

      • Vision changes or loss of vision

      • Problems with balance, walking or loss of coordination

      • Headache (uncommon)

    • These symptoms can be temporary over minutes to hours and this can be a sign of future stroke

    • Initial diagnosis starts with clinical assessment of the symptoms and examination

    • CT angiography and MRI angiography are essential to see the narrowing of blood vessels in the brain

    • Perfusion imaging with CT and MRI is useful to characterise the degree of reduced blood flow occurring because of the vessel narrowing

    • A cerebral angiogram with a catheter can be useful to get detailed information of the blood vessels

    • Blood tests are useful to check the patient’s risk factors such as cholesterol, diabetes and clotting profile

    • Medical management (first line)

      • Blood thinning medication such as antiplatelet drugs such as aspirin and clopidogrel

      • Cholesterol-lowering medicines such as statins

      • Lifestyle changes such as healthy diet, exercise and stopping smoking

      • In severe cases medications to increase the blood pressure may be necessary

    • Procedures (in selected circumstances with failed medical treatment)

      • Angioplasty and stenting: a balloon and sometimes a stent are used to open the narrowed artery

      • Bypass surgery: may be useful in select rare cases to create a new path for blood to flow around the blockage to supply the brain

dr andrew gauden intracranial atherosclerotic disease

For Referring Doctors

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Doctors are encouraged to call the rooms for urgent questions about patients. For all other requests and referrals, please email directly via this form.