Translation. Region: Russian Federation –
Source: Moscow Government – Government of Moscow –
Stroke is an acute disorder of blood supply to the brain, in which it is important to provide fast and high-tech assistance. In Moscow, a stroke network has been created on the basis of the largest multidisciplinary hospitals, which includes 13 specialized centers. In anticipation of World Stroke Day, which is celebrated on October 29, we tell you about one of them – at the flagship emergency care center City Clinical Hospital (CCH) No. 15 named after O.M. Filatov.
A mos.ru correspondent followed in the footsteps of a patient at a stroke center and talked to doctors. How a multidisciplinary team is formed, what high-tech equipment allows finding the brain lesion and performing minimally invasive intervention, and what a hybrid operating room looks like — in our report.
Beyond the Red Line. From the Ambulance to the Shock Ward
Severe headache, nausea and vomiting, loss of consciousness or loss of consciousness, convulsions. These symptoms are typical of both ischemic stroke (impaired blood circulation due to vascular occlusion) and hemorrhagic stroke (ruptured blood vessels, causing blood to enter tissues). The first step is to call an ambulance team, which will take you to the nearest stroke center with a free operating room. Osman Osmanov, Deputy Chief Physician for Emergency Care at City Clinical Hospital No. 15 named after O. M. Filatov, shows an information board installed in the admissions department of the flagship center on the first floor.
“Already on the way, the ambulance team gives us information about the patient. On the board, we see what time the acute condition arose, what is the level of consciousness according to the Glasgow Coma Scale and hemodynamic indicators: blood pressure, pulse, respiratory rate, saturation. In all flagship centers, the “triage” system has been implemented, according to which people are distributed among functional zones depending on the priority of assistance: red, yellow or green. Critical patients are marked on the board in red. Stroke is always “red”. Due to a blood clot in a vessel, brain tissue is damaged due to starvation,” Osman Osmanov specified.
Meanwhile, a patient arrives at the center. There is a separate entrance for ambulances: through a spacious box separated from the reception area by glass doors. These doors open automatically for the team. Following the red line on the floor, it takes the patient to the anti-shock department. Doctors simultaneously register the person and collect a full anamnesis from the ambulance paramedics. Five minutes after arriving at the center, the patient is taken to the CT room.
A multidisciplinary team is formed for each new case, emphasized Ikram Tagirov, head of the resuscitation and intensive care department for patients with acute cerebrovascular accident.
“Not a minute can be wasted in vascular accidents, the life and subsequent rehabilitation of a person depend on our actions. That is why stroke centers are opening in Moscow, where there is everything for diagnostics and provision of qualified medical care for such pathologies: CT, MRI, ECG, at least two angiographs, laboratory equipment. We have four X-ray surgical operating rooms, one of which is hybrid. A multidisciplinary team of neurologists, resuscitators, specialists in radiation diagnostics, and X-ray endovascular surgeons is on duty around the clock. They are ready to meet the patient when they see on the board that he is coming. Sometimes a stroke or a heart attack occurs, then we involve cardiologists. If it turns out not to be a stroke, but a hematoma, then we involve neurosurgeons,” the doctor explained.
From the triage system to the “space” operating room: how the flagship center of the O.M. Filatov Hospital No. 15 is organizedMoscow doctors have developed a technique for diagnosing childhood strokes — SobyaninSobyanin: Vascular centers received 8 angiographs with 3D modeling functionOver the past eight years, Moscow doctors have managed to increase the number of operations performed to remove blood clots by more than 30 times.
Computed tomography for scanning the bloodstream
The council is assembled right in the CT room. First of all, blood is taken for analysis and a native CT examination is performed (without contrast agent): the overall picture is assessed. Then, if indicated, CT angiography is performed to detect cerebral artery occlusion.
If a hemorrhage or a space-occupying lesion of the brain is detected during a native examination, the patient is consulted by a neurosurgeon. When a person with an ischemic stroke is admitted in the therapeutic window (the time when a drug that dissolves a clot can be administered to a patient in this condition) and in the absence of contraindications, the question of thrombolytic therapy (TLT) arises. This is the breakdown of blood clots using medications. The faster the procedure is performed, the better the effect and the lower the neurological deficit. Thrombolytic therapy has strict time limits – 4.5 hours from the onset of symptoms, noted neurologist Zaretta Kurbanova.
“We usually understand whether a particular patient is suitable for thrombolytic therapy before the ambulance arrives, since we know the onset time of the disease. If we are convinced by native CT that the ischemic focus (zone of dead cells) has not yet formed, we perform thrombolytic therapy and administer a thrombolytic drug. By that time, the test results are ready, because before thrombolysis it is important to check hemoglobin, platelets, and a coagulogram. After a native examination of the brain, if there are indications, we proceed to CT angiography. Contrasting the vessels allows us to scan the bloodstream and find the site of blockage that caused the stroke. It is in the CT examination room that a neurologist and an X-ray endovascular surgeon decide whether endovascular intervention (thromboextraction) is possible, that is, surgical extraction of a thrombus,” said Zaretta Kurbanova.
In case of intracerebral hematoma, angiography is used to find the source of the hemorrhage and the patient is transferred to a neurosurgeon. Diagnostic procedures take about 30-40 minutes. The next stage is the operating room.
Inside the “space” operating room. Stenting and thrombus extraction
We leave the CT room and call the “red” elevator. The doors open immediately, and we go in a spacious cabin to the third floor – to the operating and resuscitation unit. If an intervention were planned, the anesthesiologist would already be waiting for us here. Most often, operations are performed under general anesthesia: the patient should not move while the surgeon works with microinstruments on small vessels.
We put on a doctor’s suit – gowns, caps, masks – and go into the hybrid operating room. This is the heart of the stroke center, and doctors call it “Cosmos”. The latest generation angiographic complex, an artificial blood circulation machine, and ultrasound devices are installed here. Cardiovascular and general surgeons, traumatologists, gynecologists and other specialists can work together in the operating room. To understand all the sensors and monitors, we ask Sergei Korotkikh, a doctor of X-ray endovascular diagnostics and treatment, to give us a tour.
He approaches the angiographic complex, presses a button on the display, and the couch smoothly rotates in different planes. For example, it tilts to the side: in this position, cardiac surgeons can conveniently operate on the aorta. In the case of a stroke, the couch is straightened. Sergei Korotkikh presses another button, and now the angiograph tube — an X-ray machine — moves in different planes.
“With the help of an angiograph, we display a detailed image of the lesion on the screen, “remove” bone structures and build a vascular tree. The operation is performed using a minimally invasive endovascular method. Through small punctures, we insert flexible catheters into the vessel and open a stent in the thrombosis area. It is embedded in the structure of the thrombus, and we remove them both. After the intervention, we check whether the blood flow has been completely restored. And we always monitor the pressure: it can jump or fall sharply. After the thrombus is removed, the blood supply is restored, and the tissue in the brain is soft, it reacts sensitively to the effects of blood,” the doctor explained.
We study angiographic images taken during operations. In the first one, the black “branches” – the blood supply – are cut off. In the second one, after treatment, they stretched across the brain again. The operation lasts about half an hour, then the person, accompanied by an anesthesiologist, is transported to the neurological intensive care unit.
On the mend. Rehabilitation and prevention of recurrent stroke
The final stage is a comprehensive examination to identify the cause of the stroke and reduce the risk of its recurrence. Rehabilitation begins in intensive care and continues in specialized centers or hospital departments.
Innovative equipment also helps to recover from a stroke. For example, training is carried out on exercise machines with biofeedback. And a glove exercise machine helps to restore fine motor skills of the hands. A neurointerface is used to restore statolocomotor disorders, control of upper limb movements, and cognitive functions. Muscovites can receive free medications to reduce the risk of secondary stroke for two years from the date of diagnosis.
The city also has a stroke prevention program. People at risk undergo ultrasound examinations of the neck vessels to detect atherosclerotic plaques, and those diagnosed with atrial fibrillation are prescribed blood thinners.
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Please note: This information is raw content directly from the source of the information. It is exactly what the source states and does not reflect the position of MIL-OSI or its clients.
Please note; This information is raw content directly from the information source. It is accurate to what the source is stating and does not reflect the position of MIL-OSI or its clients.
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