David Cánovas: "Addressing stroke in the early hours is essential in the evolution of the disease"

• December 15, 2016
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Stroke is one of the most common and important health problems today. It affects 13.000 people each year in Catalonia, causing different levels of disability to 45% of those affected. It is the leading cause of severe disability and dependency in adults and is among the top three causes of mortality in Spain. An average of two strokes are treated every day at the Emergency Department of Sabadell Hospital. Dr. David Cánovas, assistant doctor of the Neurology Service and head of the stroke program at Parc Taulí, talks about this disease.

Dr. Cánovas, what is a stroke?

Stroke is a neurological disease caused by an involvement of the arteries that irrigate the brain. It is the leading cause of disability and is among the top three causes of death. We speak of ischemic stroke, commonly referred to as embolism, thrombosis or cerebral infarction when there is an obstruction of an artery that will cause a neurological deficit whose severity will depend on the type of artery affected. The other type of stroke, hemorrhagic, better known as stroke or cerebral hemorrhage, is due to the rupture of an artery that will result in a clot with a prognosis that will depend on the size and location of the stroke. Stroke is the leading cause of death in women and the third in men in Catalonia.

What are your symptoms?

The symptoms that cause a stroke are usually of sudden onset, although they can set in minutes and even hours. The four main alarm symptoms for going to the emergency room immediately are: language disorder (inability to utter the desired word or difficulty in articulating the word and / or difficulty in understanding the language); weakness of a part of the body (may include face, arm, and leg and almost always affects only one side of the body); acute visual deficit (of the whole eye or part of the visual field) i numbness on one side of the body. The aim of the current stroke awareness campaign that is being carried out in Catalonia is to recognize the symptoms of a stroke in order to go to the hospital as soon as possible, given the possibility of an effective treatment during the first hours.

What are the risk factors that can trigger a stroke?

The most directly related risk factors for ischemic stroke are high blood pressure, smoking, sedentary lifestyle, obesity, diabetes, and hypercholesterolemia. Atrial fibrillation is the leading cause of embolic stroke. Regarding hemorrhagic stroke, if we rule out cranioencephalic trauma, the most related vascular risk factor, by far, is poorly controlled hypertension. There are other causes mainly in the young population such as aneurysms and vascular malformations.

How is the diagnosis and treatment of stroke approached at our center?

The 'stroke code' has been established, a protocol in order to start treatment as soon as possible. When the patient arrives at the Emergency Department, an immediate assessment is made and the diagnostic chain begins: CT scan, analysis, constant assessment and neurological assessment. If it is an ischemic stroke and there is no contraindication, intravenous treatment is administered. If it is a hemorrhagic stroke, the stroke code is deactivated. For more than 15 years we have had an intravenous treatment (fibrinolysis) that aims to destroy the thrombus that clogs the artery responsible for the stroke. The time we have to perform this treatment since the onset of symptoms is 4,5 hours, but the effectiveness is much greater if administered in the first hour and a half, ie as soon as possible. we manage, there are more chances of recovery. However, this treatment is effective in a small percentage of patients. We can say that it prevents death or a disabling stroke in one in seven patients treated. The other treatment we perform is thrombectomy.

What is a thrombectomy?

It is a treatment similar to that used by cardiologists during the first hours of a myocardial infarction. Endovascular thrombectomy consists of a puncture at the level of the groin to insert a catheter through the femoral artery that is able to reach the level of the arterial occlusion, so that by means of a device we can remove the thrombus. This procedure, which has been approved since 2015 and has been shown to be more effective than fibrinolysis, is performed in a few hospitals, including Parc Taulí, where we have been performing it for 8 years, from 8 am to 17 pm . Outside these hours, the patient must be transferred to the Hospital Clínic de Barcelona. We are currently working together with Mútua de Terrassa to implant thrombectomy 24 hours a day, every day of the year. Between 40 and 80 patients a year could benefit from this treatment.

In the field of research, are you working in the Neurology Service on a project on stroke?

We have collaborated with many multicenter studies together with other hospitals in Catalonia, and in international studies such as the International carotid stenting study (ICSS), Estudio Ictus (Citicoline in the acute phase of stroke), Estudio SPS 3 Secondary prevention os small subcortical strokes) or the URICOICTUS study (uric acid in the acute phase of stroke). We also collaborate with other data collection centers for all patients on a website of the Master Plan for Brain Disease (SONNIA) that allows us to publish joint data on different aspects related to the hyperacute treatment of stroke.