• Stroke Treatment and Prevention

     
     
     
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    3/01/2014

    Call 911 if you, or the person you’re with, could be having a stroke.

    A stroke is a life-threatening, potentially disabling medical emergency that requires immediate medical evaluation and treatment. Call 911 if you or someone with you experiences these symptoms:

                                Stroke Symptoms

    Timing is everything when it comes to surviving and recovering from a stroke because time is brainevery second that passes could mean the loss of more brain function, which affects your ability to think, walk, and talk.

    What to Expect at the Hospital

    After you call 911 and help arrives, the emergency response team in the ambulance and at the hospital or clinic will work to stabilize and monitor your blood pressure, temperature, heart rate, and breathing. Next, physicians and other members of the healthcare team will order tests, such as a CT scan or MRI make the diagnosis.

    If your doctor determines that you had a stroke, he or she must quickly determine if the stroke was ischemic or hemorrhagic. The treatment will be different depending on the type as stroke as well as your unique circumstances, such as your age and other risk factors.

    Ischemic Stroke Treatment

    An ischemic stroke happens when blood flow to the brain is restricted or blocked. Once the cause of the ischemic stroke is determined, the doctor may give you a dose of aspirin or other drugs to thin your blood. But do not take aspirin before coming to the emergency room because if you are having a hemorrhagic stroke, aspirin could increase bleeding.

    Opening Blocked Arteries

    If a patient who has an ischemic stroke arrives at the hospital in time, he or she may be given a clot-dissolving medicine called t-PA (tissue plasminogen activator). Patients who receive t-PA within the first three hours after their first symptoms of stroke seem to have a better chance of recovering and have fewer complications. Unfortunately, fewer than 5 percent of patients who have ischemic strokes receive this treatment because they don’t make it to the hospital in time or they are they are not diagnosed quickly enough after they arrive.

    That’s why it’s important to go to a primary or comprehensive stroke treatment center. These centers are certified as meeting certain requirements, for example, having testing equipment, such as CT Scans and MRIs available on a 24-hour emergency basis, doctors close at hand to read and interpret the results, and physicians and other healthcare professionals who specialize in recognizing and treating stroke.

    Other treatments for ischemic stroke include:

    • Surgery—A carotid endarterectomy is a surgical procedure that removes blockages from arteries in the neck that supply blood to the brain.
    • Interventional procedures—Physicians also use balloon angioplasty and stents to open up the artery blocked or narrowed by the buildup of fatty deposits, or plaque. 

    Carotid Artery Stenting

    Carotid artery stenting involves inserting a catheter (a small plastic tube) through an artery in the leg and threading it through the vessels to the blockage in the neck. A thin wire (guidewire), which has a collapsible umbrella-like filter device attached to its end, is advanced via the catheter to a point just beyond the blockage.

    When opened, the “umbrella” filters the blood flowing to the brain, preventing bits of plaque or blood clot from passing to the brain and causing stroke. The blocked artery is widened by inflating a tiny balloon inside vessel. This pushes the plaque against the artery’s walls and makes way for the stent, a small metal tube that is inserted to prop open the artery. Once the stent is in place, the umbrella filter and catheter are removed.

    For some time now, carotid artery stenting has been an effective option for patients who could be at high risk during surgery due to factors such as prior carotid artery surgery, radiation to the neck, chronic heart failure, lung disease, severe coronary artery disease and other factors. But it is quickly becoming a viable option for all patients.

    Hemorrhagic Stroke

    A hemorrhagic stroke occurs when a blood vessel in the brain bursts or weakens allowing blood to leak into the brain. It is very important with this type of stroke to control the bleeding. Do not take aspirin or any other blood-thinning medication before going to the emergency room. Like ischemic stroke, hemorrhagic stroke can be treated with surgery or interventional procedures. Depending on the stroke’s cause, your doctor may choose one of the following procedures:

    • Aneurysm clipping. If your stroke results from an aneurysm in the brain, your doctor may place a clamp at the base of the aneurysm. This separates the aneurysm from the artery to which it is attached to prevent it from bursting or rebleeding if it has already leaked blood.
    • Coiling (aneurysm embolization). In this procedure, a catheter is used to deliver a tiny coil to fill an aneurysm. This seals the aneurysm off from connecting arteries and the risk of rupture is reduced.
    • Surgical removal of AVM (malformed arteries in the brain). Surgical removal of malformed vessels in the brain may be possible if they are not too large and are accessible. Removal eliminates the possibility of their rupture and lowers the risks of hemorrhagic stroke.

    Stroke care has come a long way. Physicians have learned a lot from treating heart disease with catheter-based treatments, such as angioplasty and stenting, and they have transferred that knowledge to treating strokes. Neuro-rescue stroke treatments are revolutionizing stroke care. Emergency medical responders, hospitals, and clinics are establishing and improving systems to help patients get the help they need as quickly as they need it.

    On the Horizon

    Researchers, physicians, and other healthcare professionals continue to look for ways to improve the treatment of stroke. One way is to train more physicians in interventional procedures. Click here to watch a video about advances in training physicians to place stent in the carotid artery.

    You can also learn about new developments in stroke care by talking with your doctor about participating in a clinical trial. Click here to learn more about clinical trials and how you might participate.

    Ongoing Care

    The first few hours and days after a stroke, the patient is at great risk of having another stroke. Stroke patients are also very susceptible to serious complications that can include seizures, brain swelling, and infections, such as pneumonia. It will take time to assess how much damage was done by the stroke. Although the brain will begin to adapt and change its way of functioning to accommodate the loss of some of its parts, it can take a long time. Click here Recovering from Stroke to learn more about the long-term process of recovering from stroke.