SOCIETY OF THERAPEUTIC NEUROINTERVENTIONS

What is stroke and what causes it?• Stroke is a disease that effects the blood vessels going to the brain • Stroke happens when blood vessel going to the brain gets blocked by a clot or

bursts. • As a result of it part of brain doesn’t bet oxygen and blood it needs and dies • It is 3rd most common cause of death and disability

ISCHAEMIC STROKE HEMORRHAGIC STROKE

Why is it an emergency? • Most common reason for disability• Appx. 1 in 4 people die within 1 year • 30%–50% do not regain functional independence • Annual incidence rate of stroke in India currently is 145 per 100,000 population• 10 - 15% occur in < 40 years • WHO estimates suggest that by 2050, 80% stroke cases in the world would occur

in low and middle income countries mainly India and China

Why do we say “time is brain’

• Every minute if stroke is untreated, the average patient loses 1.9 million neurons, 13.8 billion synapses, and 12 km (7 miles) of axonal fibers.

• Each hour, in which treatment fails to occur, the brain loses as many neuron as it does in almost 3.6 years of normal aging.

• Early treatment in first few hours can reverse stroke in many patients

How can one know that stroke is happening?

Beyond F.A.S.T. – Other Symptoms You Should Know

• Sudden numbness or weakness of the leg• Sudden confusion or trouble understanding • Sudden trouble seeing in one or both eyes • Sudden trouble walking, dizziness, loss of balance or coordination • Sudden severe headache with no known cause

What should be done if stroke is happening?

• Immediately go to a hospital which can do stroke treatment • Do not wait for improvement • Do not spend time at local GP• Don’t take BP medicine• If CT doesn’t show any bleed, Aspirin tablet

Is it possible to reverse stroke?

• If the blocked blood vessel can re-opened brain tissue can be saved • If patient comes in first few hours (4.5 hrs), clot busting drug (t-PA) cab ne

given • Blood vessel can also be opened by intervention technique• Neurointerventionist goes through leg blood vessel and by special devices can

take out the clot to open up the blood vessel • By modern treatment methods may patients recover completely after stroke

Is it possible to prevent stroke?

CLOT REMOVAL BY NEUROINTERVENTION

What is mini-stroke and why is it important?

• “Mini stroke” or Transient ischemic attacks “TIAs” are temporary blockage of brain blood vessel

• In these cases stroke symptoms are present for short period• If treatment is no started many patients develop permanent stroke • “Mini-stroke” is an emergency and person should immediately go to stroke

specialist • Treatment can prevent permanent stroke from happening

What are brain aneurysms?

•Brain aneurysms are weakness “ballooning” of blood vessel of brain which burst to cause bleeding in brain •The aneurysms have to be repaired urgently to prevent repeat bleeding •Nowadays most cases can be treated by minimally invasive Neurointervention technique which are safer than open surgery• COILING•In this procedure metallic rings are placed in the aneurysm to repair the weak spot. The procedure is known as “coiling”

COILING

Is intervention and surgery possible in brain blood vessels the same way as done in heart?

• Many patients have cholesterol deposit in blood vessel to brain- this is called “carotid stenosis”. If stenosis is severe, it causes stroke.

• It is possible to remove the blockage by stent placement, same way as in heart• This a short procedure which is done with local anesthesia • Surgery can also be done to remove the cholesterol deposit.

Plaque(yellow)

Stent

Interventional Surgery

• The role of neurointervention technique of mechanical recanalization in acute stroke has been proved to be strongly positive by the recently publishes trials (MR CLEAN from Netherlands, ESCAPE from Canada, EXTENS-IA from Australia, SWIFT_PRIME from USA, and REVASCAT from Spain). The articles were published in New England Journal of Medicine in 2015.

• These studies have shown that when a major blood vessel of brain is blocked then the clot removal by neurointervention technique can result in restoration of blood flow which helps in reviving braincells leading to better recovery.

Interventional Surgery

• Since the results have been uniformly and strongly positive in all the studies, American Stroke Association and American Heart Association have approved these procedures with strongest level of recommendation– class 1; level of evidence A. According to the published guidelines, patients with occluded major blood supply to brain can be treated by this procedure if it can be started upto 6-hours of onset of symptoms.

STNI – Society Patrons

Prof NK Mishra Prof AK Gupta Prof R V Padke

Dr Anil Karapurkar Prof N Khandelwal

STNI – Office Bearers

President Vice President Vice

PresidentSantosh Josheph Mathew Cherian Shailesh B Gaikwad

Secretary Joint Secretary TreasurerUday S Limaye Vipul Gupta Manish Shrivastava

STNI – Executive Committee

Harsh Rastogi Hirdesh Sahni Jayadevan E R

Shyam Kumar NK Sukalyan Purkayastha Sunanda Anand

Vivek Gupta

Conference Organizers

Chief Patron Organizing Chairman Organizing Committee

Naresh Trehan Vipul Gupta Aditya Gupta Sumit Singh

Patron Organizing Secretary Harsh SapraAjaya Nand Jha Gaurav Goel

Dr Ajay K. Wakhloo MD ,PhD ,FAHA Professor of Radiology, Neurology and Neurosurgery Director, Division Neuroimaging and Intervention (NII) Department of Radiology University of Massachusetts , USA

Dr Naci KocerMDProfessor, NeuroradiologyIstanbul UniversityIstanbul, Turkey

Thank You