Doctors at Fortis Hospital have successfully treated a 45-year-old man for a rare and severe ischemic stroke, a condition characterized by a blockage of blood flow to the brain. The swift diagnosis and intervention were critical, as this type of stroke carries a high mortality rate and potential for lasting disability.
The patient presented at the hospital’s emergency department experiencing sudden paralysis on his left side, along with slurred speech and confusion. According to doctors, his symptoms began approximately three and a half hours prior to arrival. Initial examination by Dr. Manik Mahajan, Additional Director of Neurology and a subsequent CT scan revealed acute ischemic changes in the territory supplied by the right Internal Carotid Artery (ICA), without evidence of bleeding.
Further imaging revealed a complete blockage in a major brain artery, compounded by a second critical blockage. Dr. Mahajan explained that such cases have a significant risk of fatality, ranging from 50 to 69 percent if not addressed promptly. The situation was further complicated by a tear in the artery wall, a rare occurrence observed in less than 0.5 percent of stroke cases.
Ischemic strokes occur when a blood vessel supplying the brain is blocked, typically by a clot. This deprives brain tissue of oxygen and nutrients, leading to cell damage and neurological deficits. The ICA is a major artery in the neck that supplies blood to the front part of the brain. A blockage in this artery can have devastating consequences, affecting motor function, speech, and cognitive abilities.
The patient was immediately administered intravenous clot-dissolving medication, adhering to established international stroke guidelines. This initial step aims to break down the clot and restore blood flow. However, given the complexity of the case – the dual blockages and the arterial tear – a more invasive procedure was deemed necessary.
The patient was then taken to the interventional suite for an emergency endovascular procedure, led by Dr. Trimaan Singh Sikand and his neuro-intervention team. This minimally invasive technique involves threading a catheter through a blood vessel, typically in the groin, and guiding it to the site of the blockage in the brain. Doctors successfully removed the clots and deployed a small stent to repair the torn artery, effectively restoring blood flow. The entire procedure was completed within an hour under local anesthesia.
The use of a stent in this case is particularly noteworthy. Stents are small, mesh-like tubes that are inserted into a blood vessel to provide support and keep it open. In the context of a stroke caused by an arterial dissection (tear), a stent can help to stabilize the damaged artery and prevent further clot formation. However, stenting also carries risks, including the potential for the stent itself to become blocked or cause further damage to the artery.
Cervical artery dissection, the tear in the artery wall, is increasingly recognized as a cause of stroke, particularly in younger adults. According to a recent report from the American Heart Association, torn neck arteries are responsible for as many as 1 in 4 strokes among adults under 50. The cause of these dissections can be spontaneous or triggered by injury or sudden neck movements. A 2024 study highlighted a potential rise in cases, especially among women, though this may be linked to increased use of CT scans for diagnosis.
The case highlights the importance of rapid diagnosis and intervention in stroke management. Time is critical, as brain cells begin to die within minutes of a blockage. The “golden hour” – the first hour after symptom onset – is often cited as the window of opportunity for maximizing treatment effectiveness. The patient’s relatively quick arrival at the hospital and the availability of advanced neuro-interventional capabilities at Fortis Hospital were crucial factors in his successful outcome.
While the provided information doesn’t detail the patient’s post-operative recovery, successful revascularization (restoration of blood flow) is typically followed by a period of rehabilitation to regain lost function. This may involve physical therapy, occupational therapy, and speech therapy, depending on the specific neurological deficits experienced by the patient.
The rarity of this specific combination of factors – dual blockages and an arterial tear – underscores the complexity of stroke diagnosis and treatment. It also emphasizes the need for specialized expertise and advanced technology in stroke centers to effectively manage these challenging cases. The successful outcome in this instance demonstrates the potential for positive results even in the face of severe neurological emergencies.
