October 29 is World Stroke Day

Stroke is the second most common cause of mortality worldwide (behind heart disease), according to a 2019 World Health Organization report. The most common type of stroke globally is ischemic stroke, according to cerebrovascular neurosurgeon Andrew Grande, MD. “This happens when plaque or a blood clot blocks blood flow to an artery in or on the brain,” he explained. “That obstruction disrupts the flow of oxygen to the brain and leads to neuronal death, which creates permanent neurologic dysfunction, such as arm weakness, numbness, and difficulty with speaking and vision.”

In some people, the clot occluding the blood vessel breaks up after a short time, before any long-term damage can occur. This is called a transient ischemic attack, noted Grande. “While not technically a stroke, it is critical to seek help as these people have a high risk of another episode occurring, which can result in an ischemic stroke,” he said.

Hemorrhagic stroke is less common, continued Grande. “This happens when a blood vessel breaks open and leaks blood into the brain,” he said. “Common causes are ruptured aneurysms or arterial malformations.”

Grande is excited about some of the newer minimally invasive treatments for intracerebral hemorrhage. “I believe these treatments are changing our approach to this condition,” he said. “Research – and our own experience – have shown that successful outcomes depend on timing of the evacuation and the volume of the hemorrhage removed.” In addition, several medical device companies have developed minimally invasive devices for clot evacuation, Grande noted.

When educating about how to recognize a stroke, he uses the FAST acronym:

  • Facial asymmetry
  • Arm (or leg) weakness or numbness
  • Speech problems, and the notion that
  • Time is critical.

“People don’t always realize that these symptoms [the FAS in FAST] are associated with stroke,” he said. “It’s not black and white – it requires a degree of courage to seek help when you first realize you’re experiencing them. People often think they will just go away and end up missing the best time to call 911.”

Andrew Grande, MD

When treating stroke, Grande (pictured here) believes that while neurosurgeons are best equipped to provide comprehensive care for these patients, it requires a team. “In this country, we collaborate with paramedics, emergency medicine, stroke neurologists, neuro-interventionists, the operating room team, and the neurocritical care team,” he said. “With stroke patients, there is a core of dead tissue surrounded by a penumbra – tissue that’s at risk. The neuro ICU helps protect the penumbra to minimize brain injury. Our neurorehabilitation folks are also very important, as are researchers such as Dr. Walter Low, whose lab team focuses on re-establishing neurons in the brain that have been lost to stroke.”

What makes M Health Fairview a great place for treating stroke is this team effort. “It sets us apart from everyone,” he said. “M Health Fairview has developed a neuroscience service line that spans the entire system. The care we deliver is organized across that system and we’re all part of the same team. It enables us to use the system to maximize efficiency, reduce costs, and increase patient satisfaction.”

In addition, there is research about stroke that is being done at the U of M. “One example is our Brain Aneurysm Research Consortium that includes labs from Radiology, Neurosurgery, Mechanical Engineering, and Aerospace Engineering,” said Grande. “We get 7 Tesla scans of our patients’ aneurysms and study them using bleeding-edge technology to evaluate flow, look at the biomechanics and histology of the aneurysm walls, and begin to identify biomarkers that will give us better ways to determine if the aneurysm will grow – or not, rupture – or not, and which aneurysm will need treatment. Because we’re working with the University’s care system, we can do all this.”

One of the things that’s coming down the pipeline that could lessen the impact of stroke globally is tele-robotics. For example, a neurosurgeon based in the Twin Cities could perform surgery on someone in northern Minnesota using a semi-autonomous robot connected to the internet or via satellite, according to Grande. “It could make a profound difference for stroke treatment, not only in this region, but around the world,” he said. “There are many countries where access to stroke treatment is very limited.”

Learn more about World Stroke Day.