• Stroke Treatment and Prevention

     
     
     
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    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:

    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.

    Patent Foramen Ovale (PFO)

    A hole in the heart called a PFO is a type of atrial septal defect (ASD) that may increase the risk of stroke and migraine. We are all born with a trap-door-like opening between the left and right atria of the heart, but for most of us, it closes soon after birth. For the other 20 percent, the PFO never closes. The PFO can be closed during open-heart surgery or with less invasive interventional procedures. For more information on treatment of this congenital heart defect that may not be diagnosed until adulthood, click here.

    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 to learn more about the long-term process of recovering from stroke.

  • More on Treating and Preventing Strokes

    Diagnosing a Stroke

    How well you recover from a stroke has a lot to do with how quickly your stroke is diagnosed and treatment begins. If you or someone you’re with has the following symptoms, call 911 immediately and tell them you or the person you’re with is having a stroke and you need to go to the closest stroke treatment center.

    Preventing Stroke

    Anyone can have a stroke. But according to the National Stroke Association, 80 percent of all strokes can be prevented.

    Questions to Ask Your Doctor About Stroke

    The following questions can help you talk to your physician about your individual risk of having a stroke. Print out or write down these questions and take them with you to your appointment. Taking notes can help you remember your physician’s response when you get home.

    Recovering from Stroke

    Recovering from a stroke can be challenging and frustrating. Work with your doctor and other healthcare professionals to prevent complications and another stroke. The complications or disabilities you or your loved one face depend on the location and extent of the damage to the brain from the stroke. You may or may not have any of these difficulties. It depends how your stroke affected you.

    Resources Related to Stroke

    For more information about stroke, its symptoms, treatment, and other great resources for the survivor and his or her caregivers, visit the following sites...

    SecondsCount Stroke Caregiver Tips

    As a caregiver for someone who had a stroke, you have a lot to do and too much on your mind. Try this list of suggestions for getting organized, saving time, and helping the person you love and yourself through this challenging time.

    Stroke

    Every second counts if you or someone you love is having a stroke. A stroke is a medical emergency that requires immediate treatment. Just a few hours can make the difference between recovery or learning to walk and talk all over again—or worse still—death. If you think you might be having a stroke, don’t wait, note the time, call 911...

    Stroke Risk Factors

    You don’t have to be old to have a stroke. Anyone can have one. But some people are more at risk than others.

    The SecondsCount Stroke Risk Quiz

    How much do you know about strokes? Did you know that it’s the leading cause of adult disability and the third leading cause of death? It is, but 80 percent of strokes can be prevented! Take this quick true/false quiz to learn what you can do for yourself and those you love to prevent stroke.

    What Causes a Stroke?

    Strokes happen for two different reasons. The most common cause is blood stops flowing to the brain. The flow of blood is blocked by a clot or a buildup of a fatty substance called plaque in an artery leading to the brain—a process called atherosclerosis, or more generally, cardiovascular disease. The other reasons for strokes involve blood leaking into the brain or between the brain and the skull. These strokes happen when an artery leading to the brain bursts because it is weak or damaged from aging or years of high blood pressure. It’s important for you and your healthcare team to know the cause of the stroke to determine the best treatment.