Stroke Treatment

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A stroke requires emergency care. You will probably receive treatment in a specialized stroke unit of the hospital. A team of specialists are in charge of your care. Treatment depends on whether the stroke was ischemic or hemorrhagic, how much time has passed since symptoms started, and whether you have other medical conditions.

Treatment for an ischemic stroke or transient ischemic attack (TIA) may include medicines and medical procedures.

Medicines

The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA). It breaks up the blood clots that block blood flow to your brain. A healthcare provider will inject tPA into a vein in your arm. This type of medicine must be given within 3 hours after stroke symptoms start. People who may still have large parts of the brain without major damage may benefit from tPA even after 4.5 hours, but research on this is still ongoing. Your provider may give you tPA up to 4.5 hours after your symptoms begin or if you woke up with stroke symptoms less than 4.5 hours beforehand. The sooner treatment begins, the better your chances of recovery. If you cannot have tPA, your provider may give you an anticoagulant or blood-thinning medicine, such as aspirin or clopidogrel. This helps stop blood clots from forming or getting larger. The main side effect of these medicines is bleeding.

Medical procedures

You may need a procedure to open up blocked arteries and restore blood flow to the brain. This can be done several ways.

A thrombectomy removes the clot from the blood vessel. A surgeon puts a long, flexible tube called a catheter into your upper thigh and threads it to the blocked artery in your neck or brain. They use angioplasty and stenting, or a device called a stent retriever, to open up the blocked artery.

• Angioplasty and stenting procedures use a thin tube to insert a balloon or small mesh tube into the artery. Gently blowing up the balloon or expanding the mesh tube clears space for blood to flow more easily to the brain.
• The stent retriever is a wire mesh inside the catheter that traps the clot. The stent retriever and the blood clot are then pulled out through the tube.

If carotid artery disease caused your stroke, your provider may suggest carotid endarterectomy, a surgery to remove plaque from the carotid artery in your neck.

Hemorrhagic stroke can happen suddenly and grow worse quickly. Just like with ischemic stroke, getting treatment as quickly as possible is key to a full recovery. The type of treatment you receive depends on what part of your brain is bleeding and how much.

Medicines

Your healthcare provider may give you blood pressure medicine to lower the pressure and the strain on blood vessels in the brain. You will also stop taking any anticoagulant or blood-thinning medicines that may have led to bleeding. Depending on the type of medicine you take, your provider may give you vitamin K to help stop bleeding.

Medical procedures

There are several procedures that may be used.

• Aneurysm clipping blocks off the aneurysm from the blood vessels in the brain. This surgery helps stop bleeding from an aneurysm. It can also help prevent the aneurysm from bursting again. During the procedure, a surgeon places a tiny clamp at the base of the aneurysm.
• Blood transfusion replaces blood lost through surgery or injury. A blood transfusion is a common, safe medical procedure in which healthy donor blood is given to you through an intravenous (IV) line inserted in one of your blood vessels.
• Coil embolization blocks blood flow to or seals an aneurysm. The surgeon will insert a flexible tube called a catheter into an artery in the upper thigh. They will thread the tube to the aneurysm in your brain. The surgeon will push a tiny coil through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from bursting again.
• Draining excess fluid that has built up in the brain after a stroke and pushed the brain against the skull, causing damage, is another treatment. Draining the fluid can relieve that pressure.
• Surgery may be performed to temporarily remove part of the skull if you have a lot of swelling. This allows room for the brain to swell without putting pressure on it.
• Surgery or radiation may be used to remove or shrink an arteriovenous malformation (AVM). An AVM is a tangle of arteries and veins that can break open in the brain.
• Surgery to remove pooled blood may also be used. Typically, your provider will use surgery only if you show signs of getting worse.

In addition to treating the blockage or bleeding causing the stroke, your healthcare provider may suggest additional treatments or tests.

• Breathing support may be necessary. If your stroke makes it hard to breathe or your oxygen levels are low, you may receive ventilator support.
• Compression therapy using an air-filled sleeve on your leg can lower the risk of venous thromboembolism.
• A feeding tube may be used if it is hard for you to swallow on your own. The tube provides you with nutrients.
• Fluids may help restore proper blood pressure or blood volume if those levels are low.
• Medicine may be used to lower a fever. Your provider will watch your body temperature and may give you acetaminophen or another medicine to lower fever and prevent additional brain damage.
• Rehabilitation plans may be recommended. Before you leave the hospital, your provider will test how well you can speak, swallow, and walk. You and your provider can work together to set up a rehabilitation plan.
• Skin care will help prevent skin irritation or sores from forming. Your provider will help make sure that you have enough cushioning, your skin stays dry, and you change positions often if you cannot move well on your own.

Stroke is a life-threatening condition that can cause severe disability. Palliative care or hospice care may help some people have a better quality of life with fewer symptoms.