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How is ischemic stroke treated?

An ischemic stroke is a medical condition that occurs when blood flow to the brain is cut off by a blockage in an artery. When a stroke is occurring, it is important to seek prompt treatment. Ischemic stroke treatment consists of a combination of medication, interventional procedures and surgery.  

Medications to Break Up Clots

Immediate treatment with “clot-busting” drugs can improve the chance of survival and reduce the likelihood of disabilities.

Aspirin. Once emergency room doctors determine that your stroke is caused by an obstruction in a blood vessel, a dose of aspirin is likely to be given to thin your blood. Doctors warn not to take aspirin before coming to the emergency room: If you are having a hemorrhagic stroke, aspirin could increase bleeding. Warfarin (Coumadin), heparin and other blood-thinning drugs may also be given.
TPA (tissue plasminogen activator). TPA, or tissue plasminogen activator, is a powerful clot-busting drug that may be given, but only within the first three hours of the beginning of a stroke. It is not given to people having a hemorrhagic stroke.

 

Procedures to Open Blocked Arteries

Interventional Procedures: 

In an interventional procedure called angioplasty, doctors guide a balloon-tipped catheter (a thin tube) to the blockage in the carotid arteries in the neck. When the balloon is inflated, the plaque causing the blockage is compressed against the inside of the artery walls - and blood flow is restored. Doctors may insert a stent (a small, metal mesh tube) to help prop the vessel open. In an interventional procedure called neuro-rescue, doctors thread a catheter through the arteries to deliver a tiny device to a clot in the brain. The device forms a “basket” around the clot, enabling the physician to pull the clot from the vessel and quickly restore blood flow. 

Surgical Procedures: 

Clots in the carotid arteries in the sides of the neck that reduce or restrict blood flow to the brain may be removed through a surgical procedure called carotid endarterectomy. In this procedure, a surgeon opens the blocked artery, removes the clot and closes the artery. 

 

Rafael Alexander Ortiz
Neurosurgery

People with symptoms of acute ischemic stroke need to go to the hospital emergently for diagnosis and treatment. Some of the symptoms of acute ischemic stroke include:

  1. Sudden onset of weakness on one side of the body
  2. Inability to speak
  3. Sudden onset of numbness on one side of the body
  4. Double vision
  5. Slurred speech
  6. Dizziness

At the time of arriving to the hospital, a head CT will be done to make sure that there is no bleeding in the head in order to start the appropriate ischemic stroke treatment. The only FDA approved therapy for acute ischemic stroke is intravenous infusion of tPA (clot busting drug). Those patients with stroke caused by occlusion of one of the large arteries of the brain that do not improve within 1 hour of starting the infusion of tPA, treatment with endovascular techniques is an option. Endovascular treatments are performed by introducing a catheter through the femoral artery (artery that takes blood to the leg) and navigating to the arteries of the brain where the occlusion is to infuse tPA directly, aspirate the clot, or mechanically pull the clot out.

Patients with acute ischemic stroke will need to be admitted to the hospital to find out the cause of the stroke and institute the appropriate treatment (medications and/or procedures) to prevent another stroke from happening.

Physical, occupational, and speech therapy are very important to improve the outcome and recovery after suffering an ischemic stroke.

Therapy for ischemic stroke is usually delivered in three phases based on the amount of time since the stroke occurred. First, where appropriate, clot-dissolving (thrombolytic) drugs are administered to dissolve a blood clot blocking the artery. These are followed by anticoagulant drugs to prevent new blood clots from forming. The third phase consists of preventive medications aimed at avoiding another stroke. This three-phase course of treatment is also used for transient ischemic attacks (TIAs).
Strokes are the fourth-leading cause of death and No. 1 cause of long-term disability in the United States. “Time lost is brain lost in acute stroke,” Jeffrey L. Saver, MD, director of the UCLA Stroke Center, notes. Four out of five strokes are ischemic -- caused by blockage in a blood vessel supplying the brain.

The only proven drug treatment for such strokes is tissue plasminogen activator (tPA). If administered in the first four and a half hours after the stroke’s onset, tPA can dissolve the clot and restore blood flow in approximately 5 minutes to 40% of people. But the only moderate success rate and limited time window have led researchers to develop devices that can mechanically remove the clot during or beyond that window.

The first such device, the MERCI Retriever, was approved in 2004. The SOLITAIRE Flow Restoration Device, approved by the U.S. Food and Drug Administration in 2012, outperforms the MERCI Retriever. A mesh-columned cage, it has crossing struts that can expand and engage the clot at multiple grabbing points, pulling it out effectively. It can be used for up to eight hours after the stroke’s onset. By using SOLITAIRE in combination with tPA, doctors at advanced stroke centers are able to reliably open the arteries in 80-90% of people who have had an ischemic stroke.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.