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Stroke Treatments

Overview

A stroke occurs when the blood flow to a specific part of your brain is cut off. When this happens, the cells don’t get oxygen and begin to die, causing numerous symptoms, most commonly changes in speech and numbness or weakness of the face, legs, or arms.

The FAST quick assessment for stroke includes the following:

  • F: Check for facial droop.
  • A: Hold arms out. Does one drop downward?
  • S: Is speech abnormal, delayed, or absent?
  • T: Time to call 911 if any of these are present.

How a stroke affects you depends on the location in your brain in which the stroke occurs.

Evaluation and treatment for a stroke should begin as soon as possible. The quicker emergency treatment begins, the greater the chance of preventing lasting damage. Treatment depends on the type of stroke you’re having.

Emergency treatment for ischemic stroke

Ischemic strokes are the most common kind of stroke and occur when a blood clot blocks blood flow to your brain. Treatment for this type of stroke must start within 4.5 hours of the event and aims to break up the blood clot that’s blocking or disrupting blood flow in the brain.

Aspirin

Doctors often use aspirin in the treatment of strokes. Aspirin thins your blood and can help get blood to the affected area. Be sure to tell your doctor if you're already taking aspirin for heart disease or other conditions.

Stroke medications

Your doctor may also administer drugs to break up clots. A common intravenous drug, tissue plasminogen activator is given during an active stroke if the person is a good candidate. This medication can dissolve the clot that’s causing the stroke in order to stop it. After a stroke, your doctor may prescribe oral drugs, such as clopidogrel or warfarin. These are used to thin your blood in order to reduce the risk of stroke in the future. Statins have also been shown to reduce the incidence of future stroke.

Catheter embolectomy

If drugs don’t adequately break up the blood clot and if the stroke is acute, or localized to one area, your doctor may use a catheter to access the clot and remove it manually. The catheter is threaded through your blood vessels toward the area where the clot is lodged. Your doctor can remove the clot either by a corkscrew-like device attached to the catheter or by using clot-busting agents administered through the catheter directly into the clot.

Decompressive craniotomy

A large stroke can lead to serious swelling in the brain. In some cases, surgical intervention may be necessary if drugs don’t adequately relieve the swelling. Decompressive craniotomy aims to relieve and prevent the buildup of pressure inside of your skull before it becomes dangerous. For the procedure, your surgeon will open up a flap of bone in your skull in the area of the swelling. Once the pressure is relieved, typically the flap will be returned.

Preventive treatments for ischemic stroke

After emergency procedures, your doctor will evaluate the health of your arteries and determine what needs to be done to prevent another stroke.

Lifestyle changes

Post-stroke preventive measures mainly focus on improving cardiovascular health. This might mean lowering your blood pressure and managing your blood sugar and cholesterol, or lipid, levels. It will likely include a combination of exercise, a healthier diet, and medications to help. If you smoke, quitting smoking is an important lifestyle change for stroke prevention.

Carotid endarterectomy

This is often performed on people who’ve had an ischemic stroke due to a blocked carotid artery. The carotid arteries are the major blood vessels in the neck that supply blood to the brain. For this procedure, your surgeon will remove plaques and blockages from these arteries in order to improve blood flow and decrease the risk of future stroke.

This surgery carries the risks associated with any surgery, and also the risk that it may trigger another stroke if plaques or blood clots are released during the surgery. Protective measures are used to help reduce these risks.

Treatment for hemorrhagic stroke

Hemorrhagic stroke occurs when a brain aneurysm bursts or a weakened blood vessel leaks, causing blood to leak into your brain, creating swelling and pressure.

Unlike ischemic strokes, treatment for hemorrhagic strokes doesn’t involve blood thinners, as thinning your blood would cause the bleeding in your brain to become worse. If you’re already taking blood-thinning medications, your doctor may administer drugs to counteract these or to lower your blood pressure to slow the bleeding in your brain.

Surgery

Depending on the damage to the vessel in your brain, you may need surgery after a hemorrhagic stroke. In order for surgery to be performed successfully, the abnormal blood vessel must be in a location that the surgeon can reach.

If your surgeon can access the affected artery they may remove it completely, which reduces the risk of a future rupture. Depending on the location and size of the aneurysm, surgical removal may not be a good option.

Coiling

Your doctor may recommend a procedure called coiling. Using a catheter, your surgeon threads this through your blood vessels and into the aneurysm. Then, they release a coil of soft platinum wire into the area. The wire is about as thick as a strand of hair. This coil creates a net that prevents blood from flowing into the aneurysm. This keeps it from bleeding or rebleeding.

Aneurysm clipping

Another treatment option is clipping the aneurysm by permanently installing a clamp to prevent it from bleeding further or bursting. This procedure involves surgery and is recommended when coiling won’t be effective. Clipping is more invasive than coiling.

Rehabilitation after a stroke

Rehabilitation following a stroke depends on the extent of the damage and what part of your brain was affected. For instance, if the stroke occurred in the right side of your brain, you may need physical rehabilitation that focuses on walking up and down stairs, getting dressed, or bringing food to your mouth, as the right side of the brain controls visual-spatial functions.

You may need rehabilitation or corrective measures to also help with:

  • coordination
  • balance
  • vision
  • bowel or bladder control
  • speech
  • swallowing
  • fine motor activity, such as writing or drawing

Outlook

Having a stroke can be a serious and life-threatening event, but the sooner you get evaluated and treated, the quicker you can prevent long-term damage to your brain and body. Different kinds of strokes require different treatments, rehabilitation procedures, and preventive measures. If you’re experiencing the symptoms of a stroke, seek emergency medical attention immediately.

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