Stroke Care: Stroke Units, New Therapies, Advances and the Future
Pp. 81-97 (17)
Jeyaraj D. Pandian, Akanksha G. William, Peter Langhorne and Richard Lindley
Thrombolysis (clot dissolving using medicine) and thrombectomy (clot
removal via minimally invasive angiogram) are effective acute treatments for
ischaemic stroke, but are expensive and time limited. Specialized stroke units are
proven to manage stroke-related sequelae and complications effectively. They make
stroke treatment quicker, easier and more accessible for a larger number of patients and
have specialized staff, predefined protocols and better rehabilitation outcomes. These
stroke units have proven benefits in countries that can afford them, but should be
extended even to limited-resource settings when possible. Besides thrombolysis,
thrombectomy and stroke unit care, ongoing research is exploring medications that may
keep brain tissue in the region of a stroke alive for longer (cytoprotection),
technological advances such as nanoparticles to increase the penetration of
thrombolytic agents into the clot and stem cell therapies, all of which remain to be
proven in large-scale randomized controlled trials. As a significant number of patients
live with some level of disability, rehabilitation is important. Newer techniques to
augment traditional rehabilitation such as robots and computer-based systems and
virtual rehabilitation are some of the options currently being actively studied. These are
easy to use and have shown positive results in small scale studies, but may be costly.
Cost-effectiveness, Disability, Rehabilitation, Stem cell therapy,
Stroke units, Thrombectomy, Thrombolysis.
Department of Neurology, Christian Medical College, Ludhiana, Punjab, India.