Stroke is one of the top death cause diseases that kill many Thais. The diseases include Ischemic Stroke, Thrombotic Stroke and Embolic Stroke. Nowadays, current treatment is based on symptoms to focus on the direct cause. The most important thing for the treatment is “Time” patients who receive remedy in time have more chance for faster recovery. In addition, advanced technology like Clot Retrieval now used to provide a better treatment result to the patients.

What is Clot Retrieval?

Director of Stroke center Phyathai1 Hospital, Dr. Surat Boonyakarnkul described that it is a new medical technology used for Embolic Stroke with no surgery required so that blood can supply the brain cells in time. The brain then can normally function itself again.

What are causes of Embolic Stroke?

There are two types of stroke: Ischemic Stroke and Hemorrhagic Stroke, both cause the brain lack of the blood. As a result, function of the brain is lost. Patients will have facial palsy, motor weakness, slurred speech and half-body paralyzed.

2 Causes of Ischemic Stroke

1. 1. Plaque with the stroke located in the inner blood vessel walls. Its thickness causes stonesis. Accumulation of the plaque change quality of the blood vessels means they could be brittle,fragile and lack of flexibility. When there is rupture occurred to the vessels or vascular wall. The body then produces large clot leads to Arterial Occlusive Diseases. People with diabetes, high blood lipid or elderly are more likely to face a condition than others.

1. 1. Causes of the Arterial Occlusive Diseases is the blood clot that comes from other organs in the body. Mostly found in those having heart disease( atrial fibrillation) it leads to the abnormal blood flow which later will be obstructed in the brain.

How to notice Stroke Symptoms ?

For a guideline of symptoms observing the director said it depends on location of where the brain lost its ability to function regarding the ischemia. However, the symptoms listed as follows:

• • Mouth deformation

• • Motor weakness

• • Slurred Speech

• • Being unable to move arms (Numbness)

• • Feeling depressed

• • Abnormal Breathing (Dyspnea)

When some of the symptoms are not treated timely. Patients can die however, within 24 hours certain of them may suffer from symptoms temporary before recovering and feel better .

However, even symptoms are mild but patients must be sent to a hospital as soon as possible.

Diagnosis for the stroke

Dr. Surat added that, before treatment, doctor must detect or find the cause to provide precise diagnosis with the best treatment solution as there are two types of stroke that come with similar symptoms. Patients with both need to be treated differently.

The following guidelines required for (Stroke) treatment process

• • Evaluate symptoms, history and time that symptoms start

• • History of chronic disease, drug usage and history of surgery

• • Blood Test and CT scan

• • Magnetic Resonance Imaging(MRI)

This procedure requires medical teams to work on things quickly by well-organizing using Stroke Fast Tract. When Stroke Alert is announced by the team to every department. Therefore, everybody must be prepared for stroke patients.

Why Stroke Patient Required Emergency Treatment Immediately?
As we know that patient with stroke treated with Fibrinolytics through vein. According to medical profession, stated that the Fibrinolytics must be applied promptly as it can effectively give a result within 3 hours after the symptoms begin. Conversely, this drug can harm the patient and worsen severity if it is used when the symptoms happens for more than 6 hours.

Using the medicine might take sometime to decide based on different indications
As it could give bad side effects to the patient.

When is time for the Clot Retrieval?

For patients who are delayed for treatment with the thrombolytic or some cases after receiving the thrombolytic symptoms are not improved. That is because the large clot. As a result, the Clot Retrieval will be used for at least about 8 hours counted since the symptoms start.

The director of stroke center explained more about the treatment of stroke that the Clot Retrieval treatment has been used for almost decade in the state. In Thailand, this method only used around 2-3 years and provided only in medical school, private hospital and large hospitals. Treatment requires high medical tools and doctor expertise or experience.

How Many Doctors Participating During Clot Retrieval Process?

The procedure requires doctor expertise as well as experience of radiologist about Interventional Radiology and multidisciplinary team. Therefore, everything is safe.

What Tools Required During The Procedure?

The key equipment include 3D X-ray machine that has digital system which direct to the location where the arteries are blocked precisely.

“Clot Retrieval Procedure”

The Procedures Listed as Follows:

• An anesthesiologist will provide anesthesia to patient

• Groin area will be cleaned by a doctor

• Small lesions will be made for small catheter that is flexible for insertion .

• Insert the catheter into the large artery at the groin area.

• The doctor then will insert small surgical wire (stent) via the catheter to the clot location.

• The stent will be opened like a net to catch the clot.

• After that doctor will slowly pull the stent out through the catheter.

• The clot will be sent through the groin arteries along with the stent and blood clot.

• The catheter will be pulled through the groin.

• Area where the blood starts to bleed will be compressed by nurse.

* 10 – 15 minutes approximately to make sure the bleeding stops

* Cover wound with cleaned gauze (small size)

* Patient has to lay on bed, bending legs or moving is not allowed around 8-12 hours based on doctor decision.

* Nurses will periodically monitor if there are signs for complication.

After surgery,octors often make patients stay at care ward to prevent return of bleeding as well as complications and something disorders happens in the brain. Pulse will be checked 24 hour if condition is safe then the patient can rest in regular ward.

How to take care of stroke patient?

Guidelines for taking care of the patients after allowed him to return home Dr. Surat recommended these advices below:

• • It is important to take care of stroke patients in order to control risk factors. To avoid them patients must follow doctor suggestion sternly. For example, taking medication and giving a well treatment for high blood pressure, diabetes, high blood lipids as well as heart diseases.

• • Healthy diet is recommended for instance avoid having high fat foods, strong salty taste food which are risks of hypertension. Apart from that foods that contain high sugar can lead to obesity and diabete. For that reason, patients must replace them with foods with high fibers, vitamin, mineral such as fruits, vegetable and that are a risk factor for obesity and diabetes. It should focus on eating foods with high fiber content and high levels of vitamins and cereal.

• • Behavioral Modification by regular exercise, quit smoking and alcohol beverage as well as Stress Relief

• • If the symptoms such as paralysis, short-term memory, patients require constant-therapy by physical therapist. The treatment by therapist may have to be appointed in a hospital as several technologies needed.

• • Apart from that, mental state and support from family required.

Stroke Prevention

Dr. Surat stated again that the procedure can work effectively and be able to recover patients back to his/ her normal condition. What help prevent us from the disease listed below:

• • Being able to detect the warning signs of stroke

• • Receive urgent medical attention when signs of danger occur

• • Prevent disease by being away from risk factor

• • Exercise at least 30 minutes , 3 times a week

• • Avoid having food with strong taste (Salty, Sweet, Oily)

• • Have more fruits and vegetables avoid drinking alcohol

• • Stop smoking as well as alcoholic beverages drinking

• • Find a way to reduce stress

• • Have enough rest

Apart from that, patients require annual health check-up, blood test, blood sugar levels, when result tells about the disease, patients must immediately be sent to a hospital.