Acute Stroke Activation Programme (ASAP)


What is Acute Stroke?

There are two types of acute stroke: ischaemic stroke, due to interruption of blood flow to the brain and haemorrhagic stroke, due to bleeding into the brain. Ischaemic stroke is caused by a blood clot cutting off the blood supply to an area of the brain, depriving the brain tissue of oxygen and nutrients. As a result, the brain tissue becomes damaged and eventually dies. The effect of acute stroke depends on the location and severity of brain tissue damage. Severe stroke may result in significant permanent disability or even death.

“Time is Brain” in Acute Stroke Management
During the initial phase of acute ischaemic stroke, not all the brain tissue with interrupted blood supply becomes permanently damaged immediately. Some of this tissue can be salvaged if the blood supply can be restored within a critical time period. This time window for rescue is very short; more importantly, the earlier the blood supply can be restored, the better the outcome. This reperfusion by thrombolytic therapy is a high risk intervention and has to be conducted by a team of experienced professionals. Acute stroke management requires concerted efforts and seamless coordination of different disciplines and specialists for accurate diagnosis and prompt treatment.

What is Thrombolytic Therapy?
Thrombolysis means breaking up and dissolving of the blood clots within the blocked blood vessel. Alteplase (or rtPA) is a thrombolytic (or ‘clot-dissolving’) medicine given intravenously that can dissolve the blood clot and possibly restore the blood supply to the brain tissue affected by acute stroke. As a result, the chance of recovery after acute stroke is improved. Thrombolytic therapy is most effective if given within 3 hours from the onset of acute stroke symptoms. While on the average only 1 in 4 (26%) patients recover to full independence following an ischaemic stroke, an additional 1 in 8 (13%) patients treated with thrombolytic therapy achieve recovery to full independence. Selected patients may also benefit from thrombolytic therapy if the treatment is given up to 4.5 hours from acute stroke onset.

What are the Risks of Thrombolytic Therapy?
Haemorrhage (bleeding) in the brain or other parts of the body is the most important risk of thrombolytic therapy. Approximately 1 in 15 (6%) patients treated with thrombolytic therapy develops bleeding in the brain, which may worsen the neurological impairment or even lead to death in 1%. This type of bleeding in the damaged brain tissue can also occur naturally after an ischaemic stroke even without thrombolytic therapy. Patients who have received thrombolytic therapy will require close monitoring and control of the blood pressure during the first 24 hours. Patients with certain medical conditions that increase the bleeding risk in the brain or other organs, past history of bleeding in the brain, or with stroke onset exceeding the recommended time window may not be suitable for thrombolytic therapy. The stroke team will determine a patient’s eligibility for thrombolytic therapy based on the clinical profile and the findings on the brain scan.

What is IA Thrombectomy?
IA thrombectomy is a type of minimally invasive surgery that can be used for treatment of acute ischaemic stroke patients with large vessel occlusion.

During the procedure, the neurosurgeon will guide the instrument through the patients’ arteries to the blockage and remove the blood clot to reestablish blood flow to the affected part of the brain. IA thrombectomy is best performed within 6 hours of the onset of severe stroke. Researches have shown good functional outcome in ischaemic stroke patients receiving IA thrombectomy within 16 hours or 24 hours if they meet certain criteria with the use of perfusion scanning and AI system.

What are the Risks of IA Thrombectomy?
There are certain risks for IA thrombectomy such as blood vessel damage. The attending doctors must carefully assess the patients’ eligibility for this procedure with guidance by the data generated by the AI system. Under ASAP 2.0, patients who have undergone IA thrombectomy will be transferred to the Intensive Care Unit (ICU) for treatment and close monitoring of their blood pressure and vital signs for the next 48 hours.





Remarks about Package Charges:
  • The above prices are subject to change withoutprior notice.
  • Once a patient has opted for a package,withdrawal from the package is not allowed.

FlowChart



Beat Stroke, Act FAST
FAST
Seek immediate medical attention at a hospital when you are aware of any stroke symptoms!


Source: Hong Kong Stroke Society



For enquiry, please contact
24-hour Outpatient Service
Hong Kong Sanatorium & Hospital
Tel: (852) 2835 8602