Stroke, which more than 100,000 people experience in Korea each year, is a leading emergency condition with a high mortality rate after cancer. Because brain cells are rapidly damaged from the moment a cerebral blood vessel is blocked or ruptures, how quickly treatment begins determines the prognosis.
Stroke is broadly divided into "ischemic stroke," in which a blood vessel is blocked, and "hemorrhagic stroke," in which a blood vessel ruptures. Among these, hemorrhagic stroke involves bleeding inside the brain and, if treatment is delayed, carries a high risk of death or serious disability.
According to the first-ever assessment of hemorrhagic stroke treatment standards released recently by the Health Insurance Review & Assessment Service (HIRA), 99.9% of patients received definitive treatment, such as surgery or a procedure, within 24 hours after arriving at the hospital. Observers say Korea's emergency treatment system has reached a considerable level.
The reason a rapid treatment system matters is that a ruptured cerebral aneurysm, a leading cause of hemorrhagic stroke, can be life-threatening. Subarachnoid hemorrhage, a representative form of hemorrhagic stroke, often results from aneurysm rupture. A cerebral aneurysm occurs when part of the vessel wall weakens and balloons like a balloon; most are found without symptoms, but if they rupture, sudden severe headache, neck stiffness, nausea, and vomiting can occur.
Kwon Sun-chan, head of the Ulsan Regional Cerebrovascular Disease Center (neurosurgery professor at Ulsan University Hospital), said in an interview with ChosunBiz on the 3rd, "Because damaged brain cells are difficult to recover, how quickly treatment begins determines not only the patient's survival but also the neurological sequelae that remain afterward," adding, "In particular, with cerebral aneurysms, detecting them before rupture and deciding whether to treat at the right time is more important than anything else."
Kwon is an expert in neurovascular diseases and endovascular surgery and currently serves as head of the Stroke Center at Ulsan University Hospital and head of the Ulsan Regional Cerebrovascular Disease Center.
Treatment for cerebral aneurysms is largely divided into "clipping," which blocks the aneurysm by opening the skull, and "endovascular treatment," which is performed through the blood vessels. Recently, as medical devices and procedural techniques have advanced, endovascular treatment that does not require craniotomy has spread rapidly.
Coil embolization, a representative endovascular treatment, inserts a thin catheter through the femoral artery into the cerebral vessels and fills the aneurysm with platinum alloy coils to block blood flow.
Kwon said, "Coil embolization does not require a craniotomy, so recovery is quick, and even older patients or those for whom general anesthesia is difficult can receive treatment with relatively little burden," adding, "It is actively performed even when surgery poses a significant burden due to advanced age or systemic disease."
A flow-diverting stent is mainly used for cerebral aneurysms that are large or have a wide neck and are difficult to treat with coil embolization alone. Instead of directly sealing the inside of the aneurysm, a stent is placed at the neck to reduce blood flow, guiding the aneurysm to close naturally over time.
Advances in endovascular techniques have also broadened the pool of patients eligible for treatment. Kwon cited as a memorable case a pregnant patient who suffered a hemorrhagic stroke during pregnancy.
Kwon said, "Around pregnancy and childbirth, hemorrhagic stroke can rarely occur due to systemic hemodynamic changes, and in such cases, the greatest burden comes from having to decide the treatment direction while considering both the mother and the fetus," adding, "As a physician, I feel the greatest sense of reward when, after safely completing emergency treatment and with time, a recovered mother visits the clinic holding her child."
Kwon emphasized that to meet the golden hour of stroke and minimize aftereffects, recognizing the symptoms quickly is most important.
Kwon said, "Typical symptoms of stroke include one side of the face drooping, weakness in one arm or leg, and sudden onset of slurred speech or a language disorder that prevents understanding others," advising, "Please remember 'FAST,' which stands for face, arm, speech, time."
Kwon added, "Older patients often call their children first, but the most important thing is to call 119 before calling family," emphasizing, "You must be transported to the hospital as quickly as possible through the emergency medical system to meet the golden hour."