Dr. Gabor Toth, MD

During an angiogram, the doctor inserts a very thin, flexible tube called a catheter into a blood vessel through an opening in the groin or arm. The catheter is threaded through the body to the site of the suspected problem, where a small amount of dye is injected into the bloodstream and x-rays are taken. The dye makes the surrounding blood vessels visible via x-ray.

If necessary, certain procedures can be performed after an angiogram while the catheter is in place. Angioplasty is the use of a catheter to widen narrowed or blocked arteries. Stents are like tiny coiled springs that hold blood vessels open, and they can be placed during a catheterization. Damaged heart valves can also be repaired or replaced.

A typical angiogram takes about an hour to perform, but it may be longer if the catheterization is used to perform procedures on the blood vessels. It may be uncomfortable at times but is usually not painful. Afterwards, patients may be monitored for up to six hours to make sure any bleeding from the insertion site has stopped. They are given fluids to help flush the dye from their body. For a day or two after an angiogram it is important for patients to drink plenty of fluids and keep strenuous activity to a minimum.

During angioplasty, a patient is given a sedative while lying on a table under an x-ray machine. A catheter (a thin, flexible, and hollow tube) is inserted into the patient's skin in the arm or groin and guided into the blocked artery. Dye is injected via the catheter, and x-rays are used to position the tip of the catheter exactly at the blockage. The tiny balloon is guided through the catheter and inflated with saline. It pushes the plaque out of the way, squishing it against the walls of the artery. The balloon may be inflated and deflated several times to let blood pass by. A stent, a tiny tube of metal mesh like a spring, may be inserted to help keep the artery open. Then the x-ray is used again to check that blood is flowing properly, the catheter is removed, and the tiny incision is bandaged.

There are no nerves within veins and arteries, so an angioplasty is generally not painful. However, there may be some discomfort at the site of the incision and when the balloon is inflated. Overall, angioplasty is a very effective and low-risk procedure, useful for helping patients avoid more difficult bypass surgery.

Hemorrhagic strokes are particularly dangerous, as they may go undetected. For example, someone who forcefully hits his head may simply ice his wound and not seek medical treatment, unaware that blood is leaking into his brain from a ruptured vessel. When blood leaks into the brain, the blood gathers and begins to compress the brain tissue. At the same time, the damaged vessel does not deliver blood as it normally does. Since the brain cannot function without a steady supply of blood oxygen and nutrients, the brain begins to die and may cease functioning. Hemorrhagic strokes can result in impaired movement, speech, cognitive ability, and physical functioning and may even cause death.

Certain risk factors may increase one's likelihood for developing a hemorrhagic stroke:

• High blood pressure
• Bleeding disorders (such as hemophilia)
• Blood vessel abnormalities
• Brain tumor
• Liver disease
• Drug abuse

There are two types of hemorrhagic stroke: intracranial hemorrhage stroke and subarachnoid hemorrhage stroke. Intracranial hemorrhages cause bleeding inside of the brain, while subarachnoid hemorrhages happen when bleeding occurs in the region between the brain membrane and the brain. Both types of hemorrhagic strokes require immediate medical treatment, which can prevent severe and life-threatening brain damage. Signs of hemorrhagic stroke include:

• Fever
• Disorientation or confusion
• Difficulty speaking
• Difficulty walking
• Impaired vision
• Weakness in the face, legs, or arms
• Severe headaches

When someone suspected of having a stroke reaches the hospital, the patient will usually receive a CT or other scan that provides an image of the brain. The scan results can reveal clotted or leaking blood in the brain. Physical exams, neurological exams, and blood tests may also be used to check for blood clotting and sugar. Treatment generally begins immediately if a stroke is detected.

Hemorrhagic strokes are treated with blood-saving medication and surgery. For a hemorrhagic stroke caused by an aneurysm (blood vessel bulges) rupture, surgery might be performed to stem the bleeding. Another treatment is endovascular coiling, where a catheter (thin, hollow needle) is used to place a platinum wire coil at the spot of the aneurysm. The coil blocks bleeding and prevents the aneurysm from continuing to leak blood. A similar technique is stent-assisted coiling, which adds a stent (small wire-meshed tube) into the blood vessel to block the leaking opening of the aneurysm. These procedures are usually combined with blood-thickening medications. Blood transfusions may be administered if substantial blood loss has occurred.

Hemorrhagic stroke patients who may have lost some essential functions while the blood flow to their brains was obstructed may receive post-stroke rehabilitation to rebuild their physical and mental abilities. Some restorative treatments include occupational, physical, and speech therapy. Patients may also receive care from a neurologist, who can develop individual treatment plans, and rehabilitation psychologists who may help patients with their emotional, behavioral, and cognitive recovery. Some stroke patients require lengthy rehabilitation and may never fully regain function, while others may recover more quickly. While the fastest recovery improvements are usually seen in the first three or four months, rehabilitation from hemorrhagic stroke can last for years.

If someone begins to show signs of hemorrhagic stroke, contact emergency services and call 9-1-1 immediately, since blood flow must be restored as soon as possible to avoid significant brain damage. If an ambulance takes the person to the hospital, paramedics can initiate hemorrhagic stroke treatment as soon as the patient enters the ambulance, allowing for more prompt medical intervention and care.