Treatments
Treating a stroke quickly is of the utmost importance. The treatment depends on the type of stroke you have suffered.
Treatment for Ischemic Stroke
Treating an ischemic stroke involves quickly restoring blood flow to your brain. The idea is to dissolve the clot or clots that may be blocking blood flow. This can be done by giving medication within three hours of the start of the stroke. Quick treatment improves your chances of survival and reduces the number of complications that may result from your stroke.
Medications
Medications may include:
Tissue Plasminogen Activator (tPA)
This is a powerful clot-busting drug that is given by IV at the time of an ongoing stroke. It must be given within three hours of the onset of an ischemic stroke. It cannot be given to those having a hemorrhagic stroke.
Aspirin
This is likely to be given to you in the emergency room to help prevent you from having another stroke. But you should not take aspirin before going to the hospital. If you are having a hemorrhagic stroke, aspirin could make the situation worse.
Blood Thinners or Anti-Coagulants
Blood thinners or anti-coagulants to protect against further embolic events. These include warfarin (Coumadin), Heparin or Lovenox.
Antiplatelet Agents
Antiplatelet agents to protect against further thrombotic events. These include aspirin, clopidogrel (Plavix) or dipyridamole (Persantine, Aggrenox). Again, these are only for an ischemic stroke.
Other Medications
Other medications to treat risk factors such as hypertension, high cholesterol, diabetes.
Preventative Procedures
Revascularization
This refers to
restoring blood flow to an artery that is clogged by plaque. The carotid arteries are located on each side of the neck and provide blood flow to your brain. Blockages in the carotid arteries increase the risk of stroke. It is estimated that approximately 5 to 12 percent of new strokes are attributable to carotid artery plaques that can be revascularized. This can be achieved by an open surgical procedure, called endarterectomy, or by using catheters to deliver balloons and stents (also called angioplasty). The goal of revascularization is to prevent strokes.
Carotid Endarterectomy
This operation involves
removing plaque that has built up to narrow the carotid arteries. With a small incision in the neck, the surgeon carefully opens the clogged artery, removes the plaques, and sutures closed the artery. Endarterectomy has been the most commonly performed procedure to repair carotid arteries.
Carotid Angioplasty and Stenting
Carotid stenting is used less commonly than carotid endarterectomy even though it is a less invasive procedure and is indicated for certain patients with carotid artery blockage. It may be preferable to surgery in certain patients such as those at high risk for surgical complications.
This newer procedure involves angiography, or a picture of the carotid artery using catheters, and contrast, as described above. From there, the carotid artery is widened using a balloon-tipped catheter placed into the blocked area. The balloon is inflated, pushing the plaque against the artery walls. A stent or wire mesh tube is then placed inside the artery to help keep it open. A filter is temporarily placed beyond the blockage while the area is being treated with balloons and stents to collect any debris that may enter the bloodstream during manipulation. The filter is removed at the end of the procedure.
Complications associated with carotid angioplasty have been reduced with regular use of the filter device. Ongoing studies are comparing the two methods of revascularization for safety and long-term effectiveness. Several studies have shown comparable outcomes to surgery in certain types of patients.
Patent foramen Ovale (PFO) Treatment
A patent foramen ovale (PFO) is a heart defect that leaves an opening or flap in the septum, or wall, between the upper two chambers of the heart, or atria. Everyone has a PFO before birth but it seals shut in most people by age 2.
If you have this defect, blood can flow between the atria, which does not occur in the normal heart. When the blood moves from the right to the left atrium, it is not filtered by the lungs. If small blood clots are present in the right atrium, they can pass into the left atrium and enter the body's central circulation. A clot, or embolus, moving in this way to the brain can cause a stroke.
In patients who have strokes for which the cause cannot be pinpointed, about 40 percent turn out to have PFO. The condition may be able to be treated with medications or with surgical or catheter-based repair.
Atrial Fibrillation Treatment
Atrial fibrillation is an irregular heart rhythm that can cause blood to clot in the left atrium, or upper chamber of the heart. An embolus can break away from the clot, traveling through the body's main circulation system. A stroke results if it enters the brain and lodges in a small artery blocking blood supply beyond it.
Treatment for atrial fibrillation includes stroke prevention. This includes anticoagulants, such as warfarin (Coumadin), to reduce the formation of blood clots. A procedure to restore a normal heart rhythm may also be recommended by your cardiologist. This will likely include medications to slow the heart rate and/or maintain a regular rhythm. Please refer to the atrial fibrillation content found on this website for more information.
Treatment for Hemorrhagic Stroke
Treatment goals for a hemorrhagic stroke are to stop or prevent bleeding and, if necessary, to relieve the pressure of pooled blood in the brain. Surgery may be needed to treat a hemorrhagic stroke or to prevent another one from occurring.
Aneurysm Clipping
Your surgeon places a small clamp at the base of the aneurysm to keep it from bursting or to prevent an aneurysm that has already hemorrhaged from re-bleeding. The clip stays in place permanently. The operation involves removing a section of your skull to gain entrance to the area of the brain where the aneurysm is located. This piece of skull is replaced at the end of the procedure.
Aneurysm Coiling
This is a minimally invasive procedure that accesses the treatment area from within the blood vessel as an extension of the angiography procedure described above. In contrast to clipping, coiling does not require open surgery. A catheter or tube is inserted into the femoral artery in the groin and is guided into the aneurysm. Tiny platinum coils are threaded through the catheter and placed into the aneurysm, blocking blood flow into the aneurysm thereby preventing continued growth and rupture.
AVM Removal
In some cases, a stroke may be caused by an arteriovenous malformation (AVM). This is a congenital condition, meaning that you are born with it. It involves a tangle of normal and dilated blood vessels inside the brain that allow for abnormal blood flow patterns. Certain AVMs can be surgically removed or treated with coils, depending on their size and location.
Craniotomy
A hole is cut into the skull to relieve pressure buildup in the brain caused by hemorrhagic stroke bleeding.
Rehabilitation
Complications of stroke may include paralysis or loss of muscle movement; trouble talking or swallowing; memory loss; and pain.
Stroke survivors typically need a lot of help to get over the damage they have suffered. If you have a healthy partner or close friend or relative at home, that is a big help. Even so, rehabilitation can be a long and difficult process. Recovery and rehabilitation depends on the area of the brain that was affected and how much damage was suffered.
Typically, you will be referred to a neurologist who will help plan your rehabilitation program. This 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