Transcription
I will tell you about a stroke, an ischemic stroke, what to do with it, how to act, uh, in the first hours. The thing is, there are 4 to 12 hours to save a person's life, to save them from a stroke. The thing is, the brain is the most energy-consuming organ. Our brain consumes half of all the glucose in the entire body. In children, for example, the largest vessels are the carotid artery, meaning the brain is the main consumer of energy. So, it dies colossally, uh, quickly. Every minute during a stroke, 10,000 neurons die. Every minute. Just imagine if you manage to get to, uh, a vascular center or a primary vascular department, which exists in every small town, in every one, I repeat, we have one of the best vascular networks in the world in Russia. Whoever says what, believe me, I work in this, I know it. The main task is to get there within the first 4 to 12 hours. Why 4 to 12? During this time, the brain is still alive. Yes, some cells are already irretrievably lost, but there is a possibility of recovery. And within 4 to 12 hours, thrombolysis can be performed. Even if this primary vascular center does not have an X-ray operating room and surgeons who do not operate on, uh, acute ischemic stroke, there is time to perform thrombolysis. This is a drug that is administered intravenously, and it can dissolve this fresh clot. A fresh clot, it has a rather loose consistency, and it is red in color, consisting of, uh, thrombin fibers and red blood cells. Over time, red blood cells leave, the clot hardens, turns white, and cannot be dissolved anymore. Even if some cells are still alive and can recover, you simply won't dissolve the clot. Accordingly, the faster you arrive, the more chances the doctors have to help you. The second option is endovascular surgery. That is, through the femoral artery or the artery in the arm, we access the head, uh, the artery. As a rule, it is the middle cerebral artery, about 80% of all strokes are in the basin of the middle cerebral artery, which supplies the hemisphere, right or left. And, uh, there with a special catheter, uh, a very cool, awesome catheter, we attach to the clot and pull it out, restoring blood flow. When there is an X-ray operating room and the possibility to perform surgery, it can be done within 6 hours, or if there is a border zone, meaning part of the brain has died, but part of it is still alive in this zone. Uh, then, uh, thrombectomy is performed even after 6 hours. Let's summarize. Where do we start? Factors that precede ischemic stroke in us are, uh, people who suffer from arterial hypertension. That is, if you constantly have high blood pressure, the risk increases. This is the first precursor. The second precursor is the presence of atherosclerotic plaques in the carotid arteries. It is checked simply by ultrasound, ultrasound of the neck vessels. They are clearly visible even in young people. For example, in me, uh, when I smoked, uh, the intima-media ratio, the vessel wall, there was already a slight change, a predisposition to plaque. So, you can perfectly observe the condition of your vessels through the carotid arteries. This is the second point. And if there are plaques, and the plaque is more than 60%, then it needs to be treated, operated on. Either an incision is made, inversion, uh, an incision, in general, of the carotid artery, the plaque is, uh, cleaned out of the artery. Well, like a stocking is removed from the plaque. The artery, the plaque is removed, the artery is sut Pwed, sometimes with a patch, sometimes without, it's not important. Or, uh, a gentler, uh, less traumatic operation is stenting. We access through the arm or the leg, uh, we inflate the plaque with a balloon, install a stent. Along this length, the stent expands, presses the plaque, everything works wonderfully. The presence of a plaque is a very important, uh, predictor of ischemic stroke. It is very important if there is a plaque and it is already quite large, and on ultrasound they tell you that it is somehow loose, that something is wrong with it, statins are simply essential, because statins, uh, they don't just lower cholesterol, they remove inflammation from the vascular wall, they remove inflammation from the plaque. And when the plaque is denser and not inflamed, the risk of a clot forming on it is almost nil. It is minimal. Well. And blood-thinning medications, after 55 years old, Cardiomagnyl. There are now studies and a lot of doctors who say that, like, according to this study, Cardiomagnyl is not effective at all, and so on. I will explain it to you this way: if we imagine our, there are 12 clotting factors and 12 anti-clotting factors. And these are scales, constant scales that oscillate in both directions. And when you take even a small tablet of this Cardiomagnyl or Aspirin Cardio, which slightly reduces platelet aggregation, meaning it doesn't let them stick together, it doesn't make the blood thin, it specifically reduces the sticking, you put one tablet on the side of blood thinning and clot prevention, and the scales already slightly tip. And this is often a life-saving situation. It is clear that if there are medications, uh, dual antiplatelet therapy or antiplatelet, well, different blood-thinning medications, then you need to consult with a specialist to determine the indications. Uh, such things are not appropriate to discuss on social media to a large audience. Well. So, we tip the scales, and they prevail, uh, towards clot prevention, and this saves lives. Blood pressure, plaques. The next point is arrhythmia. There is a situation when clots come from the heart, meaning from the heart due to, due to arrhythmia, when the atria do not contract fully, but flutter like at a disco. There is a small ear on the atria, like this. Well. And a small clot can form in this ear. And this clot can fly out of the ear and reach the very first vessels that branch off from the aorta. These are the vessels of the head, the most important organ that supplies blood to the heart. And again, there will be a stroke. Unfortunately, these clots are poorly dissolved by thrombolysis. And even with thrombectomy, they are difficult to remove because they are old, they have matured, they are already white clots. That's why you need to have an ECG at least once a year for arrhythmia. If you have arrhythmia, cardiologists will prescribe appropriate therapy, blood-thinning medications like Eliquis, or Xarelto, or other, uh, medications in the dosage you need. And this will prevent both the formation of a clot in the heart and its travel to your head. This is a very important point. Monitor your heart condition. In principle, that's all about the causes. Prevention, yes, prevention is controlling blood pressure. I don't think there's any point in explaining every time that blood pressure changes our vessels. It's like giving a garden hose more pressure than it's designed for. It will start to warp. And this hose, imagine, it's alive, it has the ability to reinforce itself, meaning to become denser. Uh, it has internal injuries in this hose. It seals these injuries. So, it's a living organism, vessels, and high blood pressure destroys our vessels. Therefore, we monitor blood pressure. ECG, we have discussed, be sure to monitor, uh, the heart. Ideally, also have an echocardiogram to see how it works, the condition of the myocardium, and so on. Ultrasound of the carotid arteries once a year can perfectly monitor the condition of your vessels through the carotid arteries. Yes, it won't perfectly show if you have plaques somewhere, but it's a mirror of your condition, your carotid arteries. And let's move on to lifestyle. The more you move, the better your blood is renewed. Systems and organs work completely differently. Every day, at least walk in the evening before bed for an hour. And if you walk for 1 hour every day before bed, you will see how your life will change. You will feel better, you will sleep better, because this saturation with fresh air and light, moderate physical activity before bed will ensure you deep, quality sleep, uh, less risk of, uh, arrhythmia, less risk of atherosclerosis, fewer plaques will form. In general, move more. We live in an era of hypodynamia. You need to move as much as possible. And a very important point is to give up cigarettes, because cigarettes day after day damage your vessels from the inside, destroy them. Well. And in terms of food, you don't need to give up fatty foods, but sugar. But that's a completely different story. See you in the next videos. Subscribe, like, and comment. I will try to answer. Well, maybe some of my guys will answer if possible. Take care of yourselves and be loved.