Medical Breakthroughs: Bypass for Stroke

FACTS ABOUT STROKE: The American Stroke Association defines stroke as the loss or alteration of bodily functions that results from an insufficient supply of blood to a part of the brain. The brain is an organ which need constant blood flow to function well. When blood flow is obstructed, it can result in severe damage throughout the body.

  • Stroke is the leading cause of serious, long-term disability and accounts for more than half of all patients hospitalized for neurological disease that strikes quickly.

  • About 4.5 million stroke survivors are living today.

  • Someone dies of a stroke every 3.3 minutes.

  • Someone has a stroke every 53 seconds.

  • Stroke costs the United States $30 to $40 billion per year.

TREATMENTS: There are several different types of stroke and there are a variety of treatments for them. The most promising treatment for ischemic stroke (a stroke caused by obstruction that stops blood flow) is a clot-busting drug called t-PA. It must be given to patients within three hours of the onset of symptoms. It is an effective treatment when used within that time window, but doctors say many patients do not seek treatment quickly enough.

BRAIN BYPASS: The procedure itself of connecting arteries from the scalp directly to the vessels on the surface of the brain is not new. What is new though is using modern imaging techniques to help physicians determine who will be a good candidate for the procedure.

Ideal candidates are those who have a small area of the brain that is dead, a large area that is at risk of dying, and someone who is getting worse in spite of the best efforts of the medicine and physicians. The bypass surgery restores blood flow to an area of the brain that is lacking it.

"The idea is ridiculously simple," said Howard Yonas, M.D., a neurosurgeon at the University of Pittsburgh Medical Center.

Dr. Yonas said we all have arteries above our ear that run up the side of the scalp, near the forehead. It is a small blood vessel and can be attached to a large group of vessels that rest right underneath the scalp near the ear. By using these, Dr. Yonas says you can do minimal movement with the brain.

The opening in the skull is about the size of a silver dollar and Dr. Yonas says they have a 95 percent to 98 percent success rate with a strong hook-up. He says it's important to use a small blood vessel, because you want to reintroduce blood slowly to the area. If you flood it, you risk causing more damage. Adding in a little blood flow at a time will allow the body to begin healing itself.

FURTHER STUDY: Dr. Yonas says there about 20 centers in the nation where doctors are fully trained in this procedure. He does say it is still too early to use this as a routine treatment for acute stroke. It's important to determine which candidates can benefit mostly from restoring blood flow slowly to a deprived area.


Lori Kirby, RN, CNRN
University of Pittsburgh
Medical Center-Presbyterian
200 Lothrop Street, Suite B-400
Pittsburgh, PA 15213
(412) 647-0948

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