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Initial treatment

  • Treatment differs depending on whether the stroke is ischemic or hemorrhagic. Each type of stroke also has several treatment choices. Stroke treatment is individualized so that it best meets each patient’s particular medical needs.

    Ischemic stroke

    Early treatment for an ischemic stroke focuses on dissolving or removing the blood clot in a blood vessel, or preventing further clot formation. Several types of treatment are available.

    Alteplase (clot dissolving treatment)

    This very strong drug helps dissolve the blood clot that is limiting blood flow to the brain. Treatment with alteplase is given intravenously. When it is injected in a vein, the alteplase moves through the whole body with a portion of the drug reaching the clot in the brain. It is the simplest and quickest way to begin the process of dissolving the clot.  Intravenous alteplase may prevent or limit stroke injury if given within 4 1/2 hours from the start of stroke symptoms.

    Intra-arterial treatment

      This treatment is given to some patients who have a stroke involving blockage of a large artery, especially if intravenous alteplase has been unsuccessful. A thin flexible tube (catheter) is inserted into a large artery in the groin area and guided through the major vessels of the trunk, up to the clot. Then, a device that can directly grab the clot and remove it is used to open the blood vessel and restore normal blood flow.

      Aspirin

        If the time frame has passed for the more aggressive treatments described above, aspirin is given.  Aspirin reduces the chance that additional blood clots will form.

        Hemorrhagic stroke

        Early treatment for a hemorrhagic stroke focuses on limiting more bleeding and treating the effects of the blood collection in the brain.

        Control blood pressure

        High blood pressure may contribute to more bleeding. To immediately control high blood pressure, IV medicines are used.

        Control abnormal clotting

        Some people with bleeding in the brain may be taking the drug warfarin (Coumadin®) or other blood thinners. These drugs lengthen the time it takes blood to clot and in the setting of hemorrhagic stroke, they will worsen outcome by contributing to the bleeding in the brain. Rapidly reversing this effect may require certain kinds of blood transfusions to help with clot formation.

        Reduce pressure in the cranial cavity

        If blood collects in brain tissue, pressure inside the skull may increase. In some cases, blood can block the spinal fluid drainage system in the brain, which can also increase the pressure. This problem can lead to increased fluid in the brain (hydrocephalus). The sudden development of either of these pressure problems may require surgery, insertion of a drainage tube to release pressure, or the use of select drugs.

        Prevent more bleeding

        A weakness in the wall of a blood vessel in the brain, such as a brain aneurysm (link to aneurysm information) or an arteriovenous malformation (AVM) (link to AVM information), may be the cause of the stroke. To prevent the aneurysm or AVM from bursting and bleeding again, surgery or an interventional procedure may be needed, such as:

        • Aneurysm clipping: A tiny clamp is placed at the base of the aneurysm. The clamp separates the aneurysm from the flow of blood in the artery to which it is attached. The clip stays in place permanently.
        • Coiling (aneurysm embolization): A catheter is inserted into the aneurysm. A tiny coil is then pushed through the catheter and positioned inside the aneurysm. The coil causes clotting and seals the aneurysm off from connecting arteries.
        • Surgical AVM removal, AVM embolization, or radiosurgery: It is not always possible to remove an AVM if it is too large or if it is located deep within the brain. Surgical removal of a smaller AVM from a more accessible portion of the brain can eliminate the risk of rupture or rebleeding. Use of techniques similar to aneurysm coiling may be included in the treatment plan. These techniques, called embolization, remove risk of rupture of the abnormal vessels by clotting them off. A noninvasive technique, radiosurgery, uses focused radiation to get rid of the abnormal vessels and more slowly remove the risk of rupture.
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