Stroke treatment

Emergency treatment for stroke depends on whether you're having an ischemic stroke or a stroke that involves bleeding in the brain (hemorrhagic).

Ischemic stroke treatment

To treat ischemic stroke, providers must quickly restore blood flow to your brain. This may be done with:

• Emergency IV medication: When given intravenously, therapy with drugs that can break up a clot has to be administered within 4.5 hours from when symptoms first started. The sooner these drugs are given, the better. Quick treatment not only improves your chances of survival but may also reduce complications.

The usual treatment for ischemic stroke is an IV injection of recombinant tissue plasminogen activator (tPA), also called alteplase (Activase). An injection of tPA is usually given through a vein in the arm within the first three hours. Sometimes, tPA can be given up to 4.5 hours after stroke symptoms started.

This drug restores blood flow by dissolving the blood clot causing your stroke. Quickly removing the cause of the stroke may help people recover more fully. Your provider will consider certain risks, such as potential bleeding in the brain, to determine if tPA is appropriate for you.

• Emergency endovascular procedures: Providers sometimes treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. These procedures must be performed as soon as possible:
  • Medications delivered directly to the brain: Providers insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly where the stroke is happening. The time window for this treatment is somewhat longer than for injected tPA but is still limited.
  • Removing the clot with a stent retriever: Providers can use a device attached to a catheter to directly remove the clot from the blocked blood vessel in your brain. This procedure is particularly beneficial for people with large clots that can't be completely dissolved with tPA. This procedure is often performed in combination with injected tPA.

The time window when these procedures can be considered has been expanding, due to newer imaging technology. Providers may order perfusion imaging tests (done with CT or MRI) to help determine how likely it is that someone can benefit from endovascular therapy.

Other procedures

To decrease your risk of having another stroke or mini-stroke, your provider may recommend a procedure to open up an artery narrowed by plaque. Options vary depending on your situation, but include:

• Carotid endarterectomy:Carotid arteries are the blood vessels that run along each side of your neck, supplying your brain (carotid arteries) with blood.
  This surgery removes the plaque blocking a carotid artery and may reduce your risk of ischemic stroke. A carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
• Angioplasty and stents: In an angioplasty, a surgeon threads a catheter to your carotid arteries through an artery in your groin. A balloon is then inflated to expand the narrowed artery. A stent can then be inserted to support the opened artery.

Hemorrhagic stroke treatment

Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing the pressure in your brain caused by the excess fluid. Treatment options include:

• Emergency measures: If you take blood-thinning medications to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower the pressure in your brain (intracranial pressure), lower your blood pressure, prevent spasms of your blood vessels and prevent seizures.
• Surgery: If the area of bleeding is large, your provider may perform surgery to remove the blood and relieve pressure on your brain. Surgery may also be used to repair blood vessel problems associated with hemorrhagic strokes.

Your provider may recommend one of these procedures after a stroke or if an aneurysm, arteriovenous malformation (also known as an AVM, this refers to a tangle of abnormal blood vessels), or another type of blood vessel problem caused your hemorrhagic stroke:

• Surgical clipping: A surgeon places a tiny clamp at the base of the aneurysm to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can keep an aneurysm that has recently hemorrhaged from bleeding again.
• Coiling (endovascular embolization): Using a catheter inserted into an artery in your groin and guided to your brain, your surgeon will place tiny detachable coils into the aneurysm to fill it. This blocks blood flow into the aneurysm and causes blood to clot.
• Surgical AVM removal: Surgeons may remove a smaller AVM if it's located in an accessible area of your brain. This eliminates the risk of rupture and lowers the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if it's large, located deep in the brain, or its removal would cause too much of an impact on brain function.
• Stereotactic radiosurgery: Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair blood vessel malformations.

Stroke medication

Your healthcare provider might prescribe the following medication to help with stroke prevention.

Stroke prevention

Knowing your stroke risk factors, following your provider's recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you've had a stroke or a transient ischemic attack (TIA), these measures might help prevent another stroke. The follow-up care you receive in the hospital and afterward also may play a role.

Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:

• Controlling high blood pressure (hypertension): This is one of the most important things you can do to reduce your stroke risk. If you've had a stroke, lowering your blood pressure can help prevent a subsequent TIA or stroke. Healthy lifestyle changes and medications are often used to treat high blood pressure.
• Lowering the amount of cholesterol and saturated fat in your diet: Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the buildup in your arteries. If you can't control your cholesterol through dietary changes alone, your provider may prescribe a cholesterol-lowering medication.
• Quitting tobacco use: Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke.
• Managing diabetes: Diet, exercise and losing weight can help you keep your blood sugar in a healthy range. If lifestyle factors don't seem to be enough to control your diabetes, your provider may prescribe diabetes medication.

Maintaining a healthy weight: Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease, and diabetes.

• Eating a diet rich in fruits and vegetables: A diet containing five or more daily servings of fruits or vegetables may reduce your risk of stroke. The Mediterranean diet, which emphasizes olive oil, fruit, nuts, vegetables, and whole grains, may be helpful.
• Exercising regularly: Aerobic exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your levels of good cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress.
  If you do not exercise regularly, you can gradually work up to at least 30 minutes of moderate physical activity—such as walking, jogging, swimming or bicycling—on most, if not all, days of the week.
• Drinking alcohol in moderation, if at all: Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes. Alcohol may also interact with other drugs you're taking.
• Treating obstructive sleep apnea (OSA): Your provider may recommend a sleep study if you have symptoms of OSA—a sleep disorder that causes you to stop breathing for short periods repeatedly during sleep. Treatment for OSA includes a device that delivers positive airway pressure through a mask to keep your airway open while you sleep.
• Avoiding illegal drugs: Certain street drugs, such as cocaine and methamphetamine, are established risk factors for a TIA or a stroke.