Time is life when we talk about stroke

The concept of “time is the brain”, which was introduced more than two decades ago, sums up the crucial importance of time in the world. Stroke treatment. Recalling this simple sentence can distinguish between a speedy recovery, the appearance of results, or a fatal outcome after a cerebrovascular ischemic event, or stroke.

Time is crucial as this problem deprives the brain tissue of oxygen, leading to death within minutes of the onset of the stroke.

ᲔIn Spain, Stroke frequency is high. According to the report, Stroke Atlas. Spain In 2019, about 27,000 people die of stroke each year, and that number is expected to increase by 39% due to the increase in life expectancy in 2015-2035 – 65% of people with brain damage as a result of stroke are over 65 years old.

It is likely that Two out of three people Those who survive a stroke have certain types of physical consequences associated with mobility, vision or speech, as well as mood, cognitive or personality disorders.

In the face of these indicators, it is important to remember that many strokes can be avoided and that, for many of them, the speed of their action is fundamental and the key that determines greater success.

The importance of quick action

The duration of oxygen deficiency in the brain determines the degree of brain damage: the shorter the time, the less permanent damage, and the longer, the more permanent or residual damage. Because neurons are oxygen starving cells for life and function. When oxygen supply is cut off, death takes only a short time. After death, they are replaced by scar tissue that does not function as a normal brain cell.

Therefore, it is important to treat stroke as soon as possible to prevent irreversible deterioration of the nervous system. In 30% of ischemic stroke cases, the cause is a “large blood vessel” occlusion, which occurs when a large blood vessel blockage blood flow to the brain, causing nerve cells to stop working due to lack of oxygen and glucose. .

In these cases, as shown by a Spanish study published in the journal Neurological Sciences, Mechanical thrombectomy This is the most effective way to treat it. But the speed with which this technique is performed is also important.

A study, entitled Endovascular treatment time after two triage models And involving dozens of hospital specialists from the Jiménez Diaz Foundation, Ray Juan Carlos de Mostole, Infanta Elena de Valdemoro and the University of General de Villaba, all of whom were integrated into the Madrid public network, analyzing what is the fastest and most effective way of treatment. A patient who arrived at the hospital’s emergency department with a stroke.

Thrombectomy consists of “guides, catheters and Stents Through the femoral artery to the cerebral artery, where there is occlusion, ”admits Dr. Claudio Rodriguez, head of the Jimenez Diaz Foundation and King Juan Carlos Department of Interventional Neuroradiology and co-author of the study.

A technique whose effectiveness also depends It takes time to complete: The faster you act to eliminate the thrombus, the higher the survival rate and the lower the risk of consequences.

“Removing a blood clot as soon as possible and re-draining the obstructive artery is the best neuroprotective strategy we know today,” Rodriguez admits. But how can the duration of action be reduced in the event of a stroke?

Departure-doctorWhen the doctor moves and not the patient

The authors of the study, who know that a large part of the success of a thrombectomy depends on the speed with which it is performed, have noticed that the model is called To manage a doctorConsisting of a neuroradiologist center where the patient is present, instead of transferring the patient to an interventional neuroradiology center, reduces Significantly validity time.

By this time, and according to the Madrid Community Stroke Plan, patients will be rushed to a qualified center when they find themselves in a center that does not have the necessary technical and human equipment to perform mechanical thrombectomy.

But when this circle is done in the opposite direction, i.e. with a model To manage a doctor“A significant reduction in time is observed before the obstructive artery is recanalized, when it is a care group traveling to where the patient is,” said Dr. Rodriguez and Jose Carlos Fernando Ferro, head of the King’s Integrated Neurology Service, Juan Carlos, Infanta. Elena and General de Villaba and lead author of the investigation.

During a retrospective examination of cases over the past 6 years, experts were able to observe that “patient transfer may mean Delay of one and a half to two hours “In situations where an interventional neuroradiologist is the one who travels to the hospital where the patient is staying,” says Dr. Fernandez.

This circuit also allows the hospital to prepare the patient and the catheterization room upon arrival at the neuroradiologist, which speeds up time and allows the locked artery to be recanalized as quickly as possible. “Each minute of delay can lead to significant loss of neurons, which translates into loss of autonomy, functional and future cognitive problems,” Fernandez admits.

“From a scientific point of view, it is very important that our observations are similar in other countries of the world, where the model is also tested. Anchor-Doctorr, specifically, in two studies published in 2017 and 2020 in New York and Germany, respectively, ”he concludes.