Treating Stroke Patients
Treatment options vary depending on the type of stroke. No matter which type of treatment is necessary, quick stroke symptom identification and treatment delivery are always the most important factors for a good recovery.
Emergent Treatment for all types of Stroke:
- Call 911 and have the ambulance provide immediate transportation to a stroke center.
- Blood pressure management
Emergent Medical Treatment for Ischemic Stroke:
- Intravenous t-PA: If the stroke symptoms started less than three hours ago, the doctors may administer a “clot busting” drug called t-PA (tissue plasminogen activator). This drug may be successful in dissolving the blockage in the brain artery.
- Intra-arterial Interventions: If the stroke symptoms started less than 6 hours ago, highly trained doctors called neuro interventional surgeons can place a catheter in the brain arteries to look for the blockage and administer the “clot busting” medication directly at the site of the blockage or remove the clot from the artery with mechanical devices.
Other Treatments Available for Stroke:
- Decompressive craniectomy: Surgery to remove part of the skull to allow room for the affected area of the brain to swell.
- Aneurysm Clipping: Surgery that cuts off the blood flow into an aneurysm. Under general anesthesia, a section of the skull is removed and the aneurysm is located. A neurosurgeon uses a microscope to isolate the blood vessel with the aneurysm and places a small, metal, clothespin-like clip on the aneurysm’s neck, halting its blood supply. The clip remains in the person and prevents the risk of future bleeding from the aneurysm. The piece of the skull is then replaced and the scalp is closed.
- Endovascular Embolization/Aneurysm Coiling: Under general anesthesia, a neuro interventional surgeon inserts a hollow plastic tube (a catheter) into an artery (usually in the groin) and threads it using angiography through the body to the site of the aneurysm. Using a guided wire, detachable coils (spirals of platinum wire) are passed through the catheter and released inside the aneurysm. The coils fill the aneurysm, block it from circulation, and cause the blood to clot within the aneurysm, which effectively destroys the aneurysm. An angiogram will be repeated several times over a person’s life to monitor the aneurysm and coils. (National Institute of Neurological Disorder and Stroke, 2010)
- Ventriculostomy: The blood from a ruptured aneurysm and the swelling from injured brain cells can both cause a buildup of fluids within the skull that can cause further brain injury or even death. A ventriculostomy is a drainage tube that is placed through the skull and secured within the brain to allow the fluid to be carefully removed and the pressure within the skull to be monitored.
- Vasospasm Management: Blood vessels that have an aneurysm that has bled, may suddenly constrict (become narrow). This is called vasospasm and critically decreases the amount of blood flow through the vessel and may cause a new stroke. Vasospasm is treated with intravenous fluids and blood pressure medicines. Sometimes it can be treated by the neuro interventional surgeon during an angiogram by threading a catheter to the blood vessel and injecting medicine to relax the spasm.