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Procedures for Stroke Patients
When it comes to stroke recovery, sometimes surgery is needed. Neurologist Dr. Sanjeeva Reddy Onteddu discusses the surgical options that are available for stroke patients.
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Sanjeeva Reddy Onteddu, MD
Dr. Sanjeeva Reddy Onteddu, MD is a board certified neurologist.Learn more about Dr. Sanjeeva Reddy Onteddu
Transcription:
Procedures for Stroke Patients
Caitlin Whyte: When it comes to stroke recovery, sometimes surgery is needed. So to discuss our surgical options, we are joined today by Dr. Sanjeeva Onteddu, a neurologist at UAMS.
This is UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I'm Caitlin Whyte. So doctor, today, we're talking all about surgeries and strokes. So after someone has a stroke, in most cases, is surgery needed?
Sanjeeva Reddy Onteddu, MD: So first thing to understand is there are two different kinds of strokes. One is called ischemic strokes, which are more common. Ischemic strokes are caused by blockage of blood vessels in the brain. And the second kind of strokes are called hemorrhagic where the blood vessels burst and there's blood inside the brain. So typically, there are a subgroup of this hemorrhagic strokes called subarachnoid hemorrhages, where there are some aneurysms in the brain which burst out and then cause bleeding in the brain. So usually, those ones need immediate surgical intervention. That means neurosurgeon or interventional radiology. People needs to go in and do surgeries. Those are the most common kinds of surgeries we see for strokes, especially hemorrhagic strokes.
Caitlin Whyte: So let's dive into those procedures a bit more. What are our options when it comes to surgery for stroke patients of either type of stroke?
Sanjeeva Reddy Onteddu, MD: Most common causes among strokes are ischemic strokes, that's from blockage of the blood vessels. So anytime there is a blockage of blood vessel. So if patients identify the symptoms of stroke, usually easily remembered by the mnemonic BE FAST. B stands for balance, E stands for eye problems, F stands for facial droop, A stands for arm weakness, S stands for speech problems. And if you notice any one of these, the last, T stands for time to call 911.
So if they notice any one of these and they come to the hospital within four and a half hours, and sometimes even beyond, we can give you a medication called Alteplase. Alteplase is a very strong blood thinner, which dissolves the clots and is very helpful for patients with ischemic strokes. There are some other kinds of ischemic strokes when there is a big clot in the blood vessels inside the brain. For those kinds of patients, we do a procedure called a thrombectomy. This procedure is where the interventional radiologist or neurologist goes inside the arteries, go all the way to the brain and suck the clot out so that blood is restored to that part of the brain. So these are the most common acute treatments available for ischemic strokes.
When it comes to hemorrhagic stroke, if there is what we call intracerebral hemorrhage, if there is a bleeding in the brain, so usually for those kinds of patients, depending upon where the bleed is, if it's closer to the surface, then we can do surgical evacuation. That means surgeons can open the skull and take the bleed out, but it's not common. And if there are fluid pockets in the brain, if there is bleeding inside, then they can put in what we call EVD, which can drain the blood out.
Along with these, the most other common thing which we talked about initially is for patients who have aneurysms and they bleed. So they have two different kinds of treatments. Surgeons can go in and put a clip to the aneurysmal part or the interventional people can go in and put in a coil there to prevent any more leakage of blood from that area. So these are the most common procedures or treatments available for stroke patients.
Caitlin Whyte: Let's talk about the timing of surgery. When it looks like it's going to need surgical intervention, is it usually part of a process where you've tried other options or are there strokes where it's kind of, "We need to do it right now"? When does surgery usually come into the picture?
Sanjeeva Reddy Onteddu, MD: So ischemic strokes are very time-dependent. If, for any reason, there is blockage of blood vessel, so each minute of untreated ischemic stroke, you can lose about 1.9 million neurons. So it's a very time-dependent process. So the sooner we do any kind of treatments, the better. So currently, we can give tPA for most patients safely up to four and a half hours from symptom onset. That means four and a half hours since last normal time. That means if someone starts to have stroke 10 in the morning, we have until 2:30 in the afternoon to give Alteplase treatment. This is the strong blood thinner. Beyond that, the benefits will not be as useful for a stroke patient.
But if they have a clot and they're having a large stroke, we can go after the clot and suck the clot out in a procedure called thrombectomy up to 24 hours. We have to select these patients very carefully. We have to do some additional scans to see if the brain is still viable or not.
Caitlin Whyte: So once surgery has been decided upon and done, what does recovery look like?
Sanjeeva Reddy Onteddu, MD: So it depends upon how much of brain is healed both for hemorrhagic strokes and ischemic strokes. After the procedure, we repeat scans to see what is the amount of damage. If the procedure is completely successful, they opened up the clot and the brain did not suffer any brain damage. We had patients who had this procedure done yesterday, who is being discharged today from the hospital, so they're completely back to themselves and they're going home.
At the same time, we had some patients who got the procedure done, which was not completely successful. They needed some more time in the hospital and some more rehab when they go out of hospital. So it depends upon how soon we can do it. The sooner we do any kind of procedure, the better for the patient.
Caitlin Whyte: Well, doctor, is there anything else that you want patients and their loved ones to know about stroke surgeries?
Sanjeeva Reddy Onteddu, MD: So the main thing about strokes, identifying the stroke symptoms is key for anyone to notice. Again, it's easily remembered as BE FAST. Again, B stands for balance, E fo eye abnormalities, F stands for facial droop, A stands for arm weakness, S for speech and slurred speech. When you notice one of these, it's time to call 911. So the sooner you come to the hospital, the more you have good chance for getting these acute treatment and getting the procedure you need to save brain cells.
Caitlin Whyte: Well, thank you so much for your time today, doctor, and this valuable information. Of course, when it comes to strokes, timing is everything.
To make an appointment today, give us a call at (501) 686-6124. That's (501) 686-6124. And thank you for listening today. This has been UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I'm Caitlin Whyte. Stay well.
Procedures for Stroke Patients
Caitlin Whyte: When it comes to stroke recovery, sometimes surgery is needed. So to discuss our surgical options, we are joined today by Dr. Sanjeeva Onteddu, a neurologist at UAMS.
This is UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I'm Caitlin Whyte. So doctor, today, we're talking all about surgeries and strokes. So after someone has a stroke, in most cases, is surgery needed?
Sanjeeva Reddy Onteddu, MD: So first thing to understand is there are two different kinds of strokes. One is called ischemic strokes, which are more common. Ischemic strokes are caused by blockage of blood vessels in the brain. And the second kind of strokes are called hemorrhagic where the blood vessels burst and there's blood inside the brain. So typically, there are a subgroup of this hemorrhagic strokes called subarachnoid hemorrhages, where there are some aneurysms in the brain which burst out and then cause bleeding in the brain. So usually, those ones need immediate surgical intervention. That means neurosurgeon or interventional radiology. People needs to go in and do surgeries. Those are the most common kinds of surgeries we see for strokes, especially hemorrhagic strokes.
Caitlin Whyte: So let's dive into those procedures a bit more. What are our options when it comes to surgery for stroke patients of either type of stroke?
Sanjeeva Reddy Onteddu, MD: Most common causes among strokes are ischemic strokes, that's from blockage of the blood vessels. So anytime there is a blockage of blood vessel. So if patients identify the symptoms of stroke, usually easily remembered by the mnemonic BE FAST. B stands for balance, E stands for eye problems, F stands for facial droop, A stands for arm weakness, S stands for speech problems. And if you notice any one of these, the last, T stands for time to call 911.
So if they notice any one of these and they come to the hospital within four and a half hours, and sometimes even beyond, we can give you a medication called Alteplase. Alteplase is a very strong blood thinner, which dissolves the clots and is very helpful for patients with ischemic strokes. There are some other kinds of ischemic strokes when there is a big clot in the blood vessels inside the brain. For those kinds of patients, we do a procedure called a thrombectomy. This procedure is where the interventional radiologist or neurologist goes inside the arteries, go all the way to the brain and suck the clot out so that blood is restored to that part of the brain. So these are the most common acute treatments available for ischemic strokes.
When it comes to hemorrhagic stroke, if there is what we call intracerebral hemorrhage, if there is a bleeding in the brain, so usually for those kinds of patients, depending upon where the bleed is, if it's closer to the surface, then we can do surgical evacuation. That means surgeons can open the skull and take the bleed out, but it's not common. And if there are fluid pockets in the brain, if there is bleeding inside, then they can put in what we call EVD, which can drain the blood out.
Along with these, the most other common thing which we talked about initially is for patients who have aneurysms and they bleed. So they have two different kinds of treatments. Surgeons can go in and put a clip to the aneurysmal part or the interventional people can go in and put in a coil there to prevent any more leakage of blood from that area. So these are the most common procedures or treatments available for stroke patients.
Caitlin Whyte: Let's talk about the timing of surgery. When it looks like it's going to need surgical intervention, is it usually part of a process where you've tried other options or are there strokes where it's kind of, "We need to do it right now"? When does surgery usually come into the picture?
Sanjeeva Reddy Onteddu, MD: So ischemic strokes are very time-dependent. If, for any reason, there is blockage of blood vessel, so each minute of untreated ischemic stroke, you can lose about 1.9 million neurons. So it's a very time-dependent process. So the sooner we do any kind of treatments, the better. So currently, we can give tPA for most patients safely up to four and a half hours from symptom onset. That means four and a half hours since last normal time. That means if someone starts to have stroke 10 in the morning, we have until 2:30 in the afternoon to give Alteplase treatment. This is the strong blood thinner. Beyond that, the benefits will not be as useful for a stroke patient.
But if they have a clot and they're having a large stroke, we can go after the clot and suck the clot out in a procedure called thrombectomy up to 24 hours. We have to select these patients very carefully. We have to do some additional scans to see if the brain is still viable or not.
Caitlin Whyte: So once surgery has been decided upon and done, what does recovery look like?
Sanjeeva Reddy Onteddu, MD: So it depends upon how much of brain is healed both for hemorrhagic strokes and ischemic strokes. After the procedure, we repeat scans to see what is the amount of damage. If the procedure is completely successful, they opened up the clot and the brain did not suffer any brain damage. We had patients who had this procedure done yesterday, who is being discharged today from the hospital, so they're completely back to themselves and they're going home.
At the same time, we had some patients who got the procedure done, which was not completely successful. They needed some more time in the hospital and some more rehab when they go out of hospital. So it depends upon how soon we can do it. The sooner we do any kind of procedure, the better for the patient.
Caitlin Whyte: Well, doctor, is there anything else that you want patients and their loved ones to know about stroke surgeries?
Sanjeeva Reddy Onteddu, MD: So the main thing about strokes, identifying the stroke symptoms is key for anyone to notice. Again, it's easily remembered as BE FAST. Again, B stands for balance, E fo eye abnormalities, F stands for facial droop, A stands for arm weakness, S for speech and slurred speech. When you notice one of these, it's time to call 911. So the sooner you come to the hospital, the more you have good chance for getting these acute treatment and getting the procedure you need to save brain cells.
Caitlin Whyte: Well, thank you so much for your time today, doctor, and this valuable information. Of course, when it comes to strokes, timing is everything.
To make an appointment today, give us a call at (501) 686-6124. That's (501) 686-6124. And thank you for listening today. This has been UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I'm Caitlin Whyte. Stay well.