Initial treatment for a stroke depends upon a number of factors, including whether the patient is having a hemorrhagic stroke involving bleeding within the brain, or an ischemic stroke that is blocking an artery. This will determine what treatment(s) will be considered. Ischemic strokes are the most common kind of stroke, and doctors must work quickly to reestablish blood flow to the patient’s brain. The faster the patient is able to receive treatment for an ischemic stroke, the better their chances of recovery.
Clot-busting drug treatment needs to begin as soon as possible – ideally within three hours of symptom onset and up to four and a half hours at the latest. Fast treatment not only increases the chances of surviving, but may also reduce complications. An injection of tissue plasminogen activator (tPA), or alteplase, is usually administered through a vein located in the patient’s arm. This drug works by dissolving the blood clot that is causing the stroke and thus restoring blood flow. It may also help patients to recover more completely from the stroke. There are, however, risks – including the possibility of bleeding into the brain – that must first be considered.
A doctor may treat an ischemic stroke with a procedure that is performed directly within the blood vessel that is blocked. Several recent, major research studies suggest that, depending on a number of factors including the location of the blood clot, endovascular therapy may in fact be the most effective treatment for stroke. This type of therapy significantly improves patient outcomes and reduces long-term disability after a stroke. These procedures may include:
Medication delivered directly into the brain. A doctor may insert a catheter – a thin tube – into an artery located in the patient’s groin and then carefully thread it up to their brain to administer tPA straight to the place where the ischemic stroke is actually happening. This intra-arterial thrombolysis offers a somewhat longer window of time for effectiveness than intravenous tPA.
Clot removal using a stent retriever. A doctor may decide to use a thin catheter to place a device within the blood vessel that is blocked in the patient’s brain so they can trap and then remove the blood clot. This procedure is especially useful for patients with larger clots that cannot be entirely dissolved using tPA, although it is sometimes performed in conjunction with the administration of intravenous tPA.
To lower the risk of the patient experiencing another ischemic stroke or transient ischemic attack, the doctor may recommend that they undergo a procedure in order to open an artery that has become narrow due to plaque buildup. Doctors may use one of the following treatments to prevent a future stroke, depending on the specific situation:
Carotid endarterectomy. The surgeon may remove plaques from the carotid arteries along both sides of the patient’s neck leading to the brain by making an incision on the front part of the neck, opening the carotid arteries, and then removing any plaque blockages. They then repair the arteries with either stitches or with a graft made from another vein or artificial material. This may reduce the risk of future ischemic stroke; however, it does involve risks, particularly for those patients who have heart disease or other medical issues.
Angioplasty and stents. In angioplasty, the surgeon will access the carotid arteries by going through an artery in the groin so that they can carefully and safely navigate up to the carotid arteries in the neck with a catheter attached to a balloon. The balloon can then be inflated in order to enlarge the narrowed arteries. A stent is then placed inside the artery for support and to keep the blood flowing.
Even with the best treatment, recovery from stroke may take time. If you or a loved one has suffered a stroke and needs in-home care services, the caring, well-trained team at Specialty Care Services can help. Contact us 24 hours a day, seven days a week for information and assistance.