เทคนิคการใช้รังสีร่วมรักษา ทางเลือกใหม่...เพื่อผู้ป่วย “โรคสมองขาดเลือด”

<p>Stroke is a very dangerous disease that can cause sudden disability or death in patients. However, modern medical innovations like interventional radiological techniques provide new options to increase the survival rate of patients.</p>
<h2><strong><span style="color: #00826a;">What is angiography?</span> </strong></h2>
<p>Angiography is a radiological procedure that produces more accurate results than CT scans, and it can serve as an additional treatment option for some patients who cannot undergo surgery or who have high risk for surgery, such elderly patients, patients who cannot be under anesthesia for long, patients with pulmonary disease, etc. We call this intervention a vascular intervention, and there are many ways to perform the procedure throughout the entire body. While stroke is one of the leading causes of death in the Thai population and can present itself in many different forms, this interventional radiology is also a good option that can be used to treat many different kinds of patients as well.</p>
<p>Dr. Anuchit Ruamthanthong, Interventional Radiologist, explained about the treatment shortcut known as cerebral angiogram by saying that doctors insert a catheter via an artery located at the groin before injecting a contrast media (essentially a dye) in order to observe blood vessel abnormalities that show up on the x-ray screen. If an abnormality is discovered at a particular location, that location is treated.</p>
<h2><span style="color: #00826a;"><strong>Stroke is divided into 3 different types:</strong></span></h2>
<ul>
<li>Stenosis: Doctors will insert a stent to widen or dilate the stenotic blood vessel in order to permit the passage of blood.</li>
<li>Occlusion: There are 2 stages as follows:</li>
<li>When the blood clot is still new, it is easy to dissolve, and a catheter might be inserted to the site of the blood clot in order to inject rt-PA or an anti-clotting drug directly at the site. The benefits of this method are that the drug dosage is small and there are fewer complications with less time for the anti-clotting drug to reach the intended site, especially when compared with intravenous injection, since the drug in that case would have to go through the lungs, heart and liver before eventually reaching one artery after another, not to mention the fact that a higher dose would be needed, thus increasing side effects in some patients.</li>
<li>If the blood clot has formed for a long time and is quite viscous, or doctors have administered rt-PA intravenously for over 4 hours but the patient’s symptoms do not improve, then a clot retriever will be used. Accordingly, doctors have only 4-6 hours to insert a stent to retrieve the blood clot.</li>
<li>Aneurysm: Doctors will determine the severity of the case. If the patient does not require surgery, then it might be sufficient to simply insert a stent to seal the site of the aneurism.</li>
</ul>
<h2><span style="color: #00826a;"><strong>How likely are complications?</strong></span></h2>
<p>The risks in performing repairs with the use of interventional radiology depend on each patient’s symptoms. Dr. Anuchit said, “If you imagine the patient as a house, you do not know what is inside when you are looking at it from the outside. Although the exterior might look attractive, you simply cannot tell whether the inside has dilapidated floors, damaged ceilings or detached light fixtures. The first person to open it and go inside to take a look is truly an unfortunate person, since that person cannot tell whether or not a blood vessel will rupture while performing the procedure.”</p>
<p>Therefore, the first and most important risk is risk from the disease itself. Following that, you have the medical devices, since all devices can be used only once. Furthermore, doctors personally have to adhere to the principle of not allowing the patient to develop a blood clot or to have residues, and doctors have to exercise the highest level of caution. In any case, the success of interventional radiology depends on the readiness and expertise of the medical team.</p>
<h2><span style="color: #00826a;"><strong>The medical team is a major component in treating stroke patients.</strong></span></h2>
<p>Dr. Anuchit cannot perform the procedure alone. For example, in treating a patient with ischemic stroke, the doctor will receive the patient after the patient is transferred by another doctor from the Brain, Neurological and Spinal Cord Center of Phyathai 2 Hospital, which is directly in charge of caring for the patient. Once said doctor has deemed it appropriate for the patient to receive a particular treatment, Dr. Anuchit will be able to perform the procedure. Dr. Anuchit will then enter the treatment process by performing angiography, administering local anesthesia, inserting a stent or using a clot retriever. Every step performed requires the coordinated work of many departments that together form a large team, including the staff and nurses and possibly medical specialists like neurosurgeons. Dr. Anuchit opined that “this hospital is the only place where stroke cases can be handled swiftly because we are equipped and our team is prepared and capable.”</p>
<p>There are many benefits of treating stroke by relying on angiogram. For example, when the patient is not too seriously injured or has not suffered extensive blood loss, some procedures involve only a small recovery time. It might even be possible for the patient to return home after just a single day. Treatment can also be quite safe, effective and fast. Nevertheless, what causes patients to lose their chance at receiving treatment is the fact that most patients do not arrive into the hands of medical specialists in time, which is under 6 hours.</p>


Interventional radiological technique like angiography can help doctor treat stroke

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