A STROKE happends suddenly and the impact can be devastating.

An ischaemic stroke is the most common type of stroke affecting Malaysians.

It is caused by a blocked blood vessel that cuts off blood supply to a certain part of the brain. The consequences can be far reaching for the patient, especially if he or she doesn’t receive treatment in time.

Patients may experience a variety of symptoms depending on which part of the brain is affected by the stroke, says UM Specialist Centre (UMSC) a quaternary hospital consultant neurologist Professor Dr Tan Kay Sin.

An ischaemic stroke is different from a haemorrhagic stroke, where the vessel ruptures and causes bleeding in the brain, he says.

The Malaysian Society of Neurosciences’ Clinical Practice Guidelines for the management of ischemic stroke (2020) indicates that acute ischaemic stroke is a major cause of morbidity in the country and the third leading cause of mortality in Malaysia.

Dr Tan adds that about 80 per cent of strokes are ischaemic and due to lifestyle diseases like diabetes, hypertension and high cholesterol as well as smoking. These factors are contributing to an increasing number of younger Malaysians being at risk of a stroke.

“Lifestyle factors can be modified and it pays to take charge of our health early once these risk factors crop up, but with advancing age, the chances of a stroke also increase,” he says.

Equally crucial is being aware of the early signs and symptoms of a stroke so immediate action can be taken, says UMSC consultant neurointerventional radiology and endovascular neurosurgery Professor Dr Khairul Azmi Abd Kadir.

Signs like numbness or weakness in the face or limbs, confusion and slurred speech should not be dismissed he warns as time is of the essence in stroke management.

Delay may not only lead to death but also permanent disability in some cases.

About 80 per cent of strokes are ischaemic and due to lifestyle diseases like diabetes, hypertension and high cholesterol as well as smoking, says UM Specialist Centre (UMSC) a quaternary hospital consultant neurologist Professor Dr Tan Kay Sin.

STROKE MANAGEMENT

If a patient is brought to hospital immediately after the onset of symptoms, a CT scan would be able to determine the type of stroke he is suffering from, and this information would then decide the type of treatment.

“If the stroke is due to a blocked blood vessel, the on-call stroke team will decide whether the patient needs thrombolysis or thrombectomy, or a combination of both,” says Dr Khairul Azmi.

Thrombolysis involves the administration of “a clot busting medication” which enables clots to be dissolved to restore blood flow to the brain.

Thrombolysis also reduces the clot size, which helps in a thrombectomy. A thrombectomy is an endovascular neuroradiological procedure to remove the clot using a stent retriever or suction catheter to re-establish normal blood flow.

Dr Khairul Azmi says not every stroke patient will need a thrombectomy. It is done on a case by case basis and there are certain criteria to assess suitability of patients.

Dr Tan and Dr Khairul Azmi agree that thrombolytic therapy with or without thrombectomy administered within 4.5 hours from the onset of stroke symptoms will result in better outcomes for patients. Functional recovery will significantly improve if this window of opportunity is utilised. Both thrombolytic therapy and mechanical thrombectomy call for expertise and well coordinated teamwork by healthcare professionals in the field of stroke and cerebrovascular diseases.

“However, it’s important to keep in mind that with a stroke anything can happen,” cautions Dr Khairul Azmi.
Patients may seem to be recovering but suddenly develop unexpected complications.

Stroke management is not limited to life-saving treatment at the emergency department either, adds Dr Tan.

Patients will be treated in a dedicated stroke unit; in more serious cases, spend time in the intensive care unit.

Multiple consultations with various specialist doctors will also be required. There is an important process of rehabilitation to help them regain their mobility and independence. Last but not least, managing risk factors adequately will prevent future stroke recurrence and further disability.

It takes a multi-disciplinary team working together to help the patient heal, from the time he first starts experiencing symptoms to his eventual recovery and return to normal life.

Not every stroke patient needs thrombectomy. It is done on a case by case basis, says UMSC consultant neurointerventional radiology and endovascular neurosurgery, Professor Dr Khairul Azmi Abd Kadir.

Sharing advancements in treatment

UM Specialist Centre (UMSC) hosted its second installment of the quaternary clinical symposium — Master Class 2025: Cardiac, Neuro and Vascular Clinical Essentials recently.

The initiative aimed to bridge knowledge gaps in the management of vascular conditions and spine surgery.

The master class sessions explored advancements in the treatment of vascular conditions across multiple systems; neurological, cardiac, coronary, aortic, and peripheral vessels as well as the intricacies involved in managing dialysis vascular access.

The focus was also on the progress and future innovations in spine surgery, ranging from minimally invasive procedures (MIS) to the complex management of spinal deformities.

“Patients must always come first. Every decision, every investment, every innovation must ultimately benefit the people we serve. Second, that knowledge must be shared, not stored for the true measure of our expertise lies not in what we know, but in how we use that knowledge to teach, heal and inspire others,” says UMSC chairman Datuk Zulkarnain Md Eusope.

UMSC chief executive officer Norzaiton Senusi adds that a community of clinicians, researchers and healthcare professionals united by a shared purpose to care, learn and grow together is important.

“Under the theme “Cardiac, Neuro and Vascular Clinical Essentials, we focus on areas where teamwork and precision truly make a difference in saving lives,” she says.

By bridging academia and clinical practice, and turning knowledge into healing and collaboration, patients can be assured of better care.

UMSC’s Master Class 2025 was chaired by UMSC medical director and consultant neurosurgeon Professor Datuk Dr Hari Chandran Thambinayagam and featured speakers from Universiti Malaya and UMSC.