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Some Facts about Stroke

Clinical Focus

Annually, million people worldwide suffer a stroke. Of these, 5.5 million die (3 million of women and 2,5 million of men) and another 5 million are left permanently disabled, placing a burden on family and community.

The risk of death depends on the type of stroke. Stroke caused by the rupture of a cerebral blood vessel is more dangerous but less common than blockage of cerebral artery (ischemic stroke). The mortality rate for a first ischemic stroke is 10-12% at one month and 18% at six months.

During the past 30 seconds,
5   people have died of a cerebrovascular disease &
15  people have died of a cardiovascular disease.

Death counter based on statistics of the World Health Organisation

Stroke and Surgery

Various surgical and transcutaneous stenting procedures run the risk of dislocating arterial plaque material and of causing the formation of thrombi, which can block vital arteries.emboli can be monitoring using transcranial Doppler. The load of emboli to the brain can thus be estimated and the surgeon or treating physician can react accordingly with therapeutic intervention to break up potential blood clots that could disrupt cerebral blood flow.

Transcranial Doppler Ultrasound is the only technique that allows detection of asymptomatic microemboli as they circulate through the cerebral vasculature.” According to the American Academy of Neurology, “CEA (Carotid EndArterectomy) monitoring with a TCD can provide important feedback pertaining to hemodynamic and embolic events during and after surgery that may help the surgeon take appropriate measures at all stages of the operation to reduce the risk of perioperative stroke”.
Some procedures and their associated neurological risks:endarterectomy is a common surgery to remedy carotid stenosis and leads to a 2 to 7% rate of stroke.

“Stroke is the most common major complication of CEA. Its incidence was 5.5% in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and 6.5% for patients with moderate stenosis in the European Carotid Surgery Trial (ECST).”

Stenting leads to the same rate of stroke as Carotid Endarterectomy in many cases.

The phenomenon of stroke will increase in the future. This is the consequences of the
ageing of the population and more frequent cardiac surgeries. New techniques such as carotid stenting will be undertaken more frequently, involving the risk of stroke. Trends are shown by the graph below.
Prevention and rapid treatment of stroke are thus of paramount importance for saving both lives and money. systems developed and commercialized by ABMI help minimize the risk of stroke.

Embolizing Procedures

Surgical and transcutaneous procedures performed in stroke patients, such as carotid endarterectomy and carotid stent placement, present a significant risk of neurological complications, including stroke and patient's death.

A review of Brillman devoted to neurological complications of artery bypass graft (CABG) surgery found a rate of neurological complications ranging from 3% for the retrospective studies limited to the detection of patients presenting a massive stroke or a post-anoxic encephalopathy to 33% - 75% for prospective studies taking into account these major neurological complications as well as disorders of cognitive functions.

The overall incidence of cognitive decline after cardiac surgery is variable, ranging from
40-50% of patients to 79% in the early postoperative period, whereas the incidence of cognitive disorders at 6 months ranges from 19% to 57%.

Carotid endarterectomy
(CE) which is performed approximately in 400'000 patients through the world yearly, is also associated with a mortality and morbidity rate of 5% to 11%.

Moreover, MRI brain studies revealed
5-10mm diameter subcortical infarcts occurring after CE in approximately 10% of patients. With the recent publication of NASCET trialists recommending CE for symptomatic moderate internal carotid artery stenosis - between 50 and 69 % of lumen reduction - the number of CE is likely to increase in the future, requiring new neuroprotection strategies because the benefit / complication ratio of CE will be narrower in these patients.

Unmet Needs in Stroke Care & Peri-Operative Neuroprotection

Stroke is caused by a disruption of the blood supply to the brain. There are two types of stroke:

  • Occlusion of a brain artery, causing ischemic stroke (85% of strokes)
  • Rupture of a cerebral blood vessel: hemorrhagic stroke (15% of strokes)

At present, the capacity for real-time neurological monitoring of hospitalized patients is poor due to the non existence of devices able to record and integrate relevant information on the brain’s condition, and to provide automated diagnostic and decision aid.

It is however a fact that in the first days after a stroke, as well as in medical and surgical intensive care and during heart and vascular surgery, a real-time monitoring of brain functions is essential to improve the patients’ neurological outcome.

Two pieces of information turn out to be essential for clinicians:

  • Information about the blood flow inside the brain. How is the brain perfused? Is enough blood flowing in order to keep brain cells alive?
  • Information about brain emboli and brain embolization: emboli are small – solid or gaseous - particles released either during cardio-vascular surgery, during atrial fibrillation, or by atherosclerotic plaques, blood thrombi, etc.

ABMI is responding to this demand with its advanced solutions combining advanced software with miniaturized hardware.

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