Blog Harvey A. Friedman Center for Aging

Stroke intervention: Down to the last second

Written by Mohammed Abu-Salah, BS candidate at University of Missouri – Columbia, and participant in the 2023 Institute for Public Health Summer Research Program

To further broaden our understanding of mental diseases and strokes, Jordan Amar, MD, a medical resident in his last year of training at Barnes Jewish Hospital, gave students in the summer a presentation about stroke interventions. A stroke happens when a blood clot blocks the flow of blood, thus also the oxygen, to the brain. The job of the physician here is to remove the clot as quickly and efficiently as possible. This is done through the insertion of a catheter, a small medical tube, that is then threaded into the brain artery ultimately grabbing the clot and removing it from the circulation restoring blood flow to that area of the brain. Other than using a catheter, the main medicine used here is called tissue plasminogen activator (tPA). This medicine breaks up the blood clot through an injection into the vein of your arm. This medicine must be given within three hours after symptoms are shown. Time is the most valuable asset when it comes to treating a stroke.

According to the University of Rochester, approximately 1.9 million neurons die every minute the brain is deprived of blood flow. This rapidly results in the patient losing function of that region of their brain. The urgency of the treatment and how rapid the response needs to be is what fascinates me the most. Dr. Amar mentioned that it is the strokes team goal to identify and diagnose the problem within three minutes. He described how he and his team will run down the halls with a patient to get them diagnosed and treated as quickly and efficiently as possible. The speed of the work that is being done is inspiring as it shows how much the doctors care about their patients and how seriously they take their work. The adrenal rush and chaos of the moment seems stressful but meaningful. I hope that the career that I pursue later in my life will have aspects of what Dr. Amar and the stroke team are doing now, with their fast-paced precise treatment that affects the patients down to the last second.

This image above shows the before and after of a stroke intervention. The photo on the left shows a brain with a blood clot. As you can see in the image, this blood clot is causing a lack of blood flow to that area of the brain meaning that the brain is not getting sufficient oxygen. The photo on the bottom shows the blood clot when it was removed from the brain using a catheter. The catheter is the small metal pipe located at the top of the middle picture. Once the blood clot was removed, blood flow was restored to the brain as shown in the right photo. The blood clot is gone, and the blood is adequately circulating throughout the brain sufficiently oxygenating it and ideally returning normal function to the brain.