Stroke Treatment at BIDMC
Stroke is a medical emergency and requires immediate medical treatment. Treatment for an ischemic stroke (dissolving or removing a clot) is different from treatment for hemorrhagic stroke (stopping a brain bleed). An accurate diagnosis is essential before treatment begins.
Beth Israel Deaconess Medical Center offers a number of advanced treatments for stroke. They include the following.
Tissue plasminogen activator (tPA): Our acute stroke team provides rapid diagnostic assessment and intravenous tPA for patients with acute ischemic stroke who present in the Emergency Department within a few hours from symptom onset. This FDA-approved, clot-busting drug can stop a stroke in progress and reduce disability. You can read more about tPA here.
Mechanical clot disruption: Doctors are now able to treat patients who have ischemic stroke but arrive in the Emergency Department too late to benefit from tPA, or those who do not respond to tPA. Using specialized neurointerventional, minimally invasive techniques, doctors can introduce tiny devices through veins and catheters to trap, retrieve and/or suction blood clots blocking vessels in the brain, and/or administer tPA. They can also introduce stents (a miniature mesh tube) to prop open a blocked artery, and coils to deflate blood-filled balloon-like pouches inside an artery (called an aneurysm).
Neurosurgery: Surgery may be needed to stop the bleeding for patients who have a ruptured aneurysm, or to save someone’s life after a stroke, if there is severe swelling of the brain. Our neurosurgeons can position a metal clip at the base of an aneurysm, or remove the abnormal vessels in an arteriovenous malformation (AVM). Sometimes surgeons can coil or clip aneurysms using minimally invasive techniques instead of an open surgical procedure.
Carotid endarterectomy or carotid stenting: Our vascular surgeons are recognized for exemplary results in surgical repair of the carotid artery (endarterectomy) for stroke prevention. In this procedure, doctors surgically remove blockage/fatty deposits from the carotid artery in the neck. Our vascular surgeons and neurointerventionalists are also experienced in performing carotid artery stenting, an endovascular, catheter-based procedure, which unblocks narrowing of the carotid artery to prevent a stroke in patients who might be at high risk from surgery.
Patent foramen ovale (PFO) closure in highly selected patients: Another stroke prevention treatment, this procedure closes an opening or flap in the wall between the upper two chambers of the heart. This heart defect may cause blood clots, which can move to the brain and cause a stroke.
Clinical trials: Certain patients who have had a stroke may qualify for treatment in a clinical trial. These are scientific studies that are designed to find better treatments for stroke based on the most updated information from around the world.
Doctors may also prescribe a number of medications during hospitalization and at discharge to prevent recurrent stroke. These can include:
- Medications to interfere with the blood’s ability to clot, such as anticoagulants (blood thinners like coumadin) or antiplatelets (aspirin)
- Medications to treat risk factors for stroke, such as hypertension (high blood pressure), high cholesterol and diabetes
Recovery from stroke depends on which area of the brain was affected and how much brain tissue was damaged. Stroke complications can include paralysis or loss of muscle movement; trouble talking or swallowing; problems with memory or judement; behavior changes; and pain.
Recovery can be a long, difficult and lifelong process. Our neurologists can help plan your rehabilitation program, which may include:
- Physical therapy to help you regain as much movement as possible
- Occupational therapy to help you in everyday tasks and self-care
- Speech therapy to improve swallowing and speech problems
The National Stroke Assocation also has a number of fact sheets on recovery.