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Stroke Treatments - The Basics

What You Need to Know About Stroke Treatments

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Updated August 28, 2009

Stroke Treatments - The Basics
The most effective stroke treatments can only be given within the first few hours after a stroke has occurred. Once you are identified by ambulance or emergency personnel as someone who could be having a stroke, doctors will first need to know when your symptoms started. They will also need to make sure that your symptoms are not the result of bleeding inside your brain, as medical treatments for stroke can worsen bleeding. This information will help them determine what type of stroke you are having and what type of treatment you will need.

There are two main types of stroke treatment:

Treatment of Ischemic Stroke

The treatment of ischemic stroke aims to dissolve, remove, or shatter a blood clot that is preventing blood from reaching an area of the brain. The most common treatments for ischemic stroke are the following:

Intravenous TPA
This is the first line of treatment against ischemic stroke. Tissue plasminogen activator or TPA is injected into the bloodstream through an intravenous line. TPA travels in the blood until it reaches the clot that is causing the stroke. Once there it begins to break up the clot until blood can flow past it toward the affected areas.

What is TPA?

It is important to note that intravenous TPA cannot be given to people who come into the emergency room more than three hours after the onset of their symptoms for two important reasons: First, three hours after the onset of symptoms TPA is no longer effective; second: Three hours after the onset of symptoms TPA can increase the risk of bleeding inside the brain. This is one of the most important reasons why you should call 911 immediately after you feel stroke-like symptoms.

Intra-Arterial Thrombolysis
This treatment, which depending on the location of the stroke in the brain can be given for up to 6 hours after the onset of symptoms, consists of the injection of TPA, or a similar agent, directly into the blood clot that is causing the stroke. To do this, a special small catheter is inserted into one of the major blood vessels in the leg, and is strategically advanced towards the brain using a special video system. Once the blood clot is found, the small catheter is passed into its center where the injection is delivered. After sometime, the TPA, or similar agent, begins to dissolve the blood clot until blood can flow past the clot towards the area of the stroke. Unfortunately, because this treatment requires special equipment and technical expertise, it is only available in selected hospitals around the country.

The MERCI Retriever
The Mechanical Embolus Retrieval in Cerebral Ischemia, or MERCI retriever, is a recently developed approach to remove or break up blood clots that have wandered into a small blood vessel causing it to become occluded. This is done by carefully passing a special device from a blood vessel in the leg all the way into the blood vessel in the brain where the blood clot is trapped. The retriever captures the clot and pulls it out of the body, thus returning blood flow to the affected area.

Although this technique is still experimental, its results are often miraculous. However, as it is true with most technical procedures, the results of the MERCI retriever are limited by the experience of the people performing the procedure, and by the quality of the equipment used.

The main complication of the MERCI procedure is bleeding from an accidentally ruptured blood vessel.

Other standard medical therapies used in the treatment of acute ischemic stroke include:

Ischemic Stroke Basics

Treatment of Hemorrhagic Stroke

The treatment of hemorrhagic stroke aims to stop bleeding, and to remove blood which might lead to swelling and increased pressure inside the brain.

Below are the two most common causes of hemorrhagic strokes and their treatments

Ruptured Aneurysm: Aneurysms are weak portions along the wall of a blood vessel which balloon out until they rupture. Aneurysms usually rupture because of high blood pressure. Ruptured aneurysms require brain surgery to repair the damaged blood vessel.

Aneurysm Basics

Abnormal Brain Blood Vessels: Examples of these include arterio-venous malformations or AVMs, and cavernous malformations. Typically these are blood vessels that are connected to one another in an abnormal way that causes them to bleed into the brain. When these abnormal vessels bleed into the brain, surgery is often needed to remove the abnormal blood vessels.

Arteriovenous Malformation Basics

Hemorrhagic Stroke Basics

Sources:

The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators High-Dose Atorvastatin after Stroke or Transient Ischemic Attack New England Journal of Medicine 2006 355:549-559 August 10, 2006.

The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group Tissue Plasminogen Activator for Acute Ischemic Stroke New England Journal of Medicine December 14 1995 333:1581-1588.

Anthony Furlan, MD; Randall Higashida, MD; Lawrence Wechsler, MD; Michael Gent, DSc; Howard Rowley, MD; Carlos Kase, MD; Michael Pessin, MD; Arvind Ahuja, MD; Fred Callahan, MD; Wayne M. Clark, MD; Frank Silver, MD; Frank Rivera, MD; for the PROACT Investigators Intra-arterial Prourokinase for Acute Ischemic Stroke The PROACT II Study: A Randomized Controlled Trial Journal of the American Medical Association 1999;282:2003-2011.

Y. Pierre Gobin, MD; Sidney Starkman, MD; Gary R. Duckwiler, MD; Thomas Grobelny, MD; Chelsea S. Kidwell, MD; Reza Jahan, MD; John Pile-Spellman, MD; Alan Segal, MD; Fernando Vinuela, MD Jeffrey L. Saver, MD MERCI 1 A Phase 1 Study of Mechanical Embolus Removal in Cerebral Ischemia Stroke 2004;35:2848.

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