Treatment

Emergency treatment for stroke depends on whether you’re having an ischemic stroke, hemorrhagic stroke or TIA. Each type has unique characteristics that will determine the course of treatment your physician will recommend.

Treatment of Ischemic Stroke

To treat an ischemic stroke, doctors strive to restore blood flow to the brain as quickly as possible. This can be done with medications or procedures. Immediate treatment not only improves the chances of survival but may reduce complications.

Medication for Ischemic Stroke

Some patients will benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called Alteplase. This potent clot-busting drug needs to be given within 3 hours after stroke symptoms begin. TPA restores blood flow by dissolving the blood clot causing the stroke, preventing further damage to the brain tissue, resulting in less disability, and may even help people recover fully. TPA can be dangerous and requires intense patient monitoring. Physicians must consider certain risks, such as potential bleeding in the brain, when determining whether TPA is an appropriate medication. Not all patients are candidates for this drug.

Medications for ischemic stroke could also include anti-platelets, such as asprin, and anti-coagulants, such as warfarin. These help prevent blood clots from forming, and are preventative treatment given following a stroke to prevent future strokes from occurring.

Medical Procedures for Ischemic Stroke

Physicians often treat ischemic strokes with procedures that must be performed as soon as possible.  Depending on the location the blood clot and the length time that has elapsed since the onset of the stroke, these treatments may include Intra-arterial Thrombolysis or Mechanical Thrombectomy.

During the procedure called Intra-arterial Thrombolysis, a catheter is inserted through an artery in the groin and then threaded into the brain to deliver a tissue plasminogen activator (TPA) directly to the site where the stroke is occurring.

Mechanical Thrombectomy also uses a catheter to maneuver a tiny device into the brain to physically break up or grab and remove the clot resulting in restoration of blood flow to the brain.

While both methods have proven effective, recent studies suggest patients with a clot blocking a large vessel benefit more from mechanical retrieval of the clot that just treatment with TPA. These patients show a better outcome and have less disability following a stroke. This is why it is so important to be able to identify a large vessel occlusion stroke and take the patient to a hospital that offers endovascular treatment – not all hospitals do.

Treating to Treatment of Hemorrhagic Stroke

Emergency treatment of hemorrhagic stroke focuses on controlling the factors contributing to bleeding and reducing pressure in the brain. This usually involves lowering the arterial blood pressure with intravenous drugs and may require surgery to evacuate the blood.

Medications for Hemorrhagic Stroke

If the patient currently takes medications making him/her more susceptible to bleeding, such as anticoagulants, he or she may be given drugs to reverse the effects the drug. Blood transfusion can also be utilized in effort to control further bleeding. Patients may also be given medications to lower intracranial pressure, reduce elevated blood pressure, prevent spasms in the blood vessels, or prevent seizures. During this time, stoke patients require increased monitoring and management and will be transferred to intensive care unit.

Medical Procedures for Hemorrhagic Stroke

Surgery may be used to repair blood vessel abnormalities or evacuate the blood associated with hemorrhagic strokes. The physician may recommend one of the following procedures after a stroke, or if an aneurysm or vein abnormality such as arteriovenous malformation (AVM), or other type of vascular deformity caused the hemorrhagic stroke:

In a procedure called coiling – or endovascular embolization – a Neurointerventionalists inserts a catheter into an artery in the groin and guides it to the brain using X-ray imaging. The physician then guides tiny detachable coils into the aneurysm. The coils fill the aneurysm, which blocks blood flow into the space and it prevents it from further bleeding.

If an endovascular approach is not suitable, a neurosurgeon may place a tiny clamp at the base of the aneurysm to stop blood flow to it. This clamp can keep the aneurysm from bursting, or prevent re-bleeding of an aneurysm that has recently hemorrhaged.

Neurointerventionalists and Neurosurgeons can treat AVMs by selecting an endovascular approach or surgical approach. The procedure will be selected based on the location and characteristics of the AVM.

Once the bleeding in the brain stops, treatment usually involves supportive medical care and prevention of bleeding reoccurrence.

Treatment of Transient Ischemic Attack (TIA or Mini-Stroke)

Medications for Treatment of TIA

Most stroke patients are prescribed anti-platelets and lipid lowering drugs.

Since TIA is a warning sign of a possible impending stroke, a full work up will be done to determine what stroke risk factors the patient has. Depending on test findings, the patient may need treatment to open up an artery narrowed by plaque. This may be done by Carotid Endarterectomy or Angioplasty.

Medical Procedures for Transient Ischemic Attack

In a Carotid Endarterectomy, a vascular surgeon removes plaque from the carotid arteries. In this procedure, the surgeon makes an incision along the front of the neck, opens the carotid artery and removes the plaque. The surgeon then repairs the artery with stitches or a patch made from a vein or graft. This procedure may reduce the risk of future ischemic stroke, yet also involves risks, especially for people with heart disease or other medical conditions.

In an Angioplasty, a surgeon gains access to the carotid arteries through an artery in the groin. From there, the physician can safely navigate to the neck. A balloon is then used to expand the narrowed artery. A stent can be inserted to support the opened artery.