Stroke Q&A with Dr. Vito Mantese

As reported in St. Louis Woman magazine, "Ask the Doctor"
May 2008

May is American Stroke Month, and St. John’s Mercy is taking this opportunity to provide important information about this prevalent disease.

Q: What is a stroke?

A: Stroke, also called brain attack, occurs when blood flow to the brain is disrupted. Disruption in blood flow is caused when either a blood clot or piece of plaque blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

Brain cells begin to die after just a few minutes without blood or oxygen. The loss of brain function may impair movement, speech, thinking, vision and other vital body functions, depending on the size and location of the stroke.

Q: What are the warning signs of a stroke?

A: The American Stroke Association is raising awareness about the warning signs of stroke and the importance of getting to the emergency department fast with a campaign called, “Give Me 5: Walk, Talk, Reach, See, Feel.” The campaign offers a quick stroke check using five short words:

• Walk - Is their balance off?
• Talk - Is their speech slurred or face droopy?
• Reach - Is one side weak or numb?
• See - Is their vision all or partly lost?
• Feel - Is their headache severe?

If any of these stroke symptoms occur suddenly, call 9-1-1. Every second counts and may improve the patient’s odds of survival and recovery.

Q: What are the risk factors for stroke? What can I do to reduce my risk?

A: There are two types of risk factors – those you cannot control and those you can. Factors you cannot control include:

• Age – the older you are, the higher your stroke risk
• Gender – men are generally at higher risk, but obese women and those with additional risk factors are at increased risk
• Race – African-Americans, Hispanics/Latinos and Asians are at higher risk than Caucasians
• Family history of stroke and/or heart disease
• History of prior stroke, transient ischemic attack (TIA, or mini-stroke) or heart attack.

Risk factors for stroke that you can change or medically manage include:

• Smoking – one of the best things you can do to decrease stroke risk is to stop smoking (or never start)
• High blood pressure and high cholesterol should be lowered and managed
• Heart disease (such as atrial fibrillation) should be treated
• Carotid artery disease should be treated by surgery, stenting or medical therapy
• Diabetes should be controlled through diet, oral hypoglycemics (drugs taken by mouth that lower blood sugar) or insulin
• Obesity should be medically addressed
• Excess alcohol intake should be avoided
• Physical inactivity should be avoided, as it also increases stroke risk.

Q: What are the treatment options for those who have suffered a stroke?

A: Although there is no cure for stroke, advanced medical and surgical treatments are now available, giving many stroke victims hope for optimal recovery. Your treatment plan will be determined by your physician based on your overall health, medical history, the extent of the disease and other factors.

Emergency treatment following a stroke may include:

• “Clot-busting” medications, which help dissolve blood clot(s) that cause an ischemic stroke; in order to be most effective, these agents must be given within a couple of hours of a stroke’s onset
• Medications and therapy to control brain swelling, especially after a hemorrhagic stroke
• Medications that help protect the brain from damage and ischemia (lack of oxygen).

Medications to help with stroke recovery and prevention may include:

• Anticoagulant medications, which help prevent additional blood clots from forming
• Medications that prevent platelets (a type of blood cell) from sticking together
• Medications to treat existing conditions such as diabetes, heart or blood pressure problems.

In addition, surgery may be required to help treat a stroke or prevent a stroke from occurring. The St. John’s Mercy Heart Hospital provides advanced vascular interventions and surgical techniques, including:

• Carotid endarterectomy, a surgical procedure to remove blockages from the carotid arteries, located in the neck
• Carotid artery stenting, in which a thin, flexible tube is inserted through a small puncture in the groin
• Craniotomy, a type of surgery in the brain itself to remove blood clots or repair bleeding in the brain
• Surgery to repair aneurysms (weakened, ballooned areas on artery walls that can rupture and bleed into the brain) and arteriovenous malformations (disorderly, tangled webs of arteries and veins).

In addition, St. John’s Mercy ranks in the top 10 percent in the nation and the top three in the state among Medicare providers for stroke care, according to the Centers for Medicare and Medicaid (CMS).

Speak with your physician or a vascular specialist for further information about treatment options for stroke. For assistance with finding a St. John’s Mercy physician or specialist, call 314-FOR-DOCS (toll-free: 1-888-700-7171). Access our convenient online physician directory. We welcome your comments or suggestions for future “Ask the Doctor” topics at www.stjohnsmercy.org/stlwoman.

Vito Mantese, M.D.
Vascular Surgeon
St. John’s Mercy Heart Hospital
625 S. New Ballas Road
St. Louis, MO 63141
(314) 251-6840

For more information about the Heart Hospital, please call 1-866-78-HEART.

© 2008 St. John's Mercy Health Care
615 S. New Ballas Rd., St. Louis, Missouri, 63141