Basic indications for thrombolysis (clot busting) in presumed stroke.
- Persons of a certain age (typically over 18, pediatric strokes have not been studied well and typically are due to a bleed from a congenital malformation)
- There are blood pressure ranges over which it's felt that punching holes in the brain is too dangerous
- There are certain medications (other drugs that work on the blood clotting system) that, when mixed with the clot buster make it too dangerous
- You have to have a major stroke - the procedure doesn't work all that well and a bunch of complicated statistics and people yelling back and forth have made a guess with the benefit outweighs the risk.
- TIME IS IMPORTANT - this is one of the big deals. Stroke is being popularized as a 'brain attack' (which sounds too Zombieish to me). That's a bit of overkill but the longer the symptoms have gone on, the less likely that busting up the clot is going to work. THIS IS WHERE THE SPIDER VENOM may come in - by protecting the brain while you do something (or not). Would presumably work in ischemic (formed by a blood clot) or hemorrhagic (formed by a bleeding blood vessel) kind of stroke.
- You should get permission. Thrombolysis could make things better - or kill you. The improvement rate is only 25-40% (something less than thrombolysis for heart attacks). The big downside is that you convert an ischemic stroke into a thrombolytic stroke. Since blood in the brain can't leak out anywhere, you have to drill a hole in the brain which typically requires the presence of a neurosurgeon. Lots of places don't have neurosurgeons just wandering around. Yes, we've been trained in emergent craniotomy. I have this neat stainless steel drill that looks for all the world like an old carpenter drill but you don't want me to get it out of it's case. Very, very last ditch.
IF - and a big if - this pans out it could make stroke treatment much easier and more useful. It could also be used in any sort of insult to the neurologic system (trauma, etc.).. Cryosleep anyone?
But it's a big if...