is a cardiovascular disease. It affects the blood
vessels that supply blood to the brain.
When blood flow to the brain is
impaired, oxygen and important nutrients cannot be
delivered. The result is abnormal brain function.
Blood flow to the brain can be disrupted by either a
blockage or rupture of an artery to the brain. There
are many causes for a stroke.
This is a medical emergency. Prompt treatment
could mean the difference between life and death.
Early treatment can also minimize damage to your
brain and potential disability.
Getting prompt medical treatment for stroke is important. But treatment
depends on the type of stroke.
To treat an ischemic stroke, doctors must remove any obstruction and
restore blood flow to the brain.
Therapy with clot-busting drugs must start within three hours, if given
intravenously. Quick treatment not only improves your chances of
survival, but may also reduce the amount of disability resulting from
Injection of a clot-busting (thrombolytic) drug — such as a tissue
plasminogen activator (TPA) — into your veins to dissolve a blood clot
may be more effective in increasing your chances of a full recovery,
compared with other treatment methods. Currently, though, only a small
proportion of Americans who have had a stroke receive thrombolytic
therapy. Reasons for this include:
One major limiting factor for the use of TPA-type agents is the
limited time window. Three hours has long been considered the window
within which clot-busting drugs should be administered
intravenously. Whether people can still gain some benefit from
receiving clot-busting drugs beyond three hours is uncertain. After
too much time has passed, the risks of bleeding or other
complications from this type of therapy begin to outweigh the
group of people who benefit from this therapy.
TPA-type therapy doesn't treat hemorrhagic stroke. In fact, it may
dramatically worsen a hemorrhagic stroke. Besides, not everyone who
has had an ischemic stroke is an ideal candidate for thrombolytic
therapy. The ability of TPA-type agents to dissolve blood clots also
carries with it a risk of brain hemorrhage and bleeding elsewhere.
With the diagnosis of an acute stroke, you and your doctor can work
together to weigh the risks versus benefits of thrombolytic therapy
in your individual case. Your doctor may not give you clot-busting
medications if your blood pressure isn't controllable when the TPA
is being considered.
Surgical and other procedures.
Your doctor may recommend a procedure to open up an artery that's
moderately to severely narrowed by plaques. This may include:
Your surgeon makes an incision in your neck to expose your carotid
artery. The artery is opened, the plaques are removed, and the
surgeon closes the artery. In people with marked blockages in the
carotid artery who are good candidates for the surgery, the
procedure may reduce the risk of ischemic stroke. However, there are
risks. In addition to the usual risks associated with any surgery, a
carotid endarterectomy itself can also trigger a stroke or heart
Used less commonly than carotid endarterectomy, angioplasty can
widen the inside of an artery leading to your brain, usually the
carotid artery. In this procedure, a balloon-tipped catheter is
maneuvered into the obstructed area of your artery. The balloon is
inflated, compressing the plaques against your artery walls. A
metallic mesh tube (stent) is usually left in the artery to prevent
recurrent narrowing. A recent advance in angioplasty procedures is
the use of distal protection devices, which lessen the risk of
stroke during the procedure by "catching" any material that may
break free during the procedure.
Doctors are also exploring new ways to remove clots. In a catheter
embolectomy, a catheter is threaded into one of the arteries that
lead to the brain and used to remove clots. Thrombolytic drugs may
also be administered directly into these arteries, using a catheter.
If you've had an ischemic stroke, it's important to determine why the
stroke occurred and to prevent another. Your doctor may recommend
medications to help reduce your risk of having a TIA or stroke. These
Platelets are cells in the blood that initiate clots. Anti-platelet
drugs make your platelets less sticky and less likely to clot. The
most frequently used anti-platelet medication is aspirin. Your
doctor may also consider prescribing Aggrenox, a combination of
low-dose aspirin and the anti-platelet drug dipyridamole, to reduce
blood clotting. If aspirin doesn't prevent your TIA or stroke or if
you can't take aspirin, your doctor may instead prescribe an
anti-platelet drug such as clopidogrel (Plavix) or ticlopidine (Ticlid).
These drugs include heparin and warfarin (Coumadin). They affect the
clotting system in a different manner than do anti-platelet
medications. Heparin is fast acting and is used over the short term
in the hospital. Slower acting warfarin is used over a longer term.
These drugs have a profound effect on blood clotting and require
that you work with your doctor in monitoring them closely. Your
doctor may prescribe these drugs if you have certain blood-clotting
disorders, certain arterial abnormalities, an abnormal heart rhythm
such as atrial fibrillation, or other cardiac problems.
Surgery may be used to treat a hemorrhagic stroke or prevent another
one. The most common procedures — aneurysm clipping and arteriovenous
malformation (AVM) removal — carry some risks. Your doctor may recommend
one of these procedures if you're at high risk of spontaneous aneurysm
or AVM rupture:
A tiny clamp is placed at the base of the aneurysm, isolating it
from the circulation of the artery to which it's attached. This can
keep the aneurysm from bursting, or it can prevent re-bleeding of an
aneurysm that has recently hemorrhaged.
In an embolization procedure, a catheter is maneuvered into the
aneurysm. A tiny platinum coil is pushed through the catheter and
positioned inside the aneurysm. The coil fills the aneurysm, causing
it to clot and seal itself off from connecting arteries.
It's not always possible to remove an AVM if it's too large or it's
located deep within the brain. Surgical removal of a smaller AVM
from a more accessible portion of the brain, though, can eliminate
the risk of rupture, lowering the overall risk of hemorrhagic
stroke. Other treatment options for AVMs include focused radiation
or embolization, in which the small arteries supplying the blood to
the AVM are blocked, shrinking the AVM.
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