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Stroke
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Stroke

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BRAIN & NERVOUS SYSTEM

Stroke

Stroke 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.

 

Treatment

Getting prompt medical treatment for stroke is important. But treatment depends on the type of stroke.

Ischemic stroke
To treat an ischemic stroke, doctors must remove any obstruction and restore blood flow to the brain.

Emergency treatment. 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 the stroke.

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:

  • The limited time window. 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 potential benefits.

  • The limited 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:

  • Carotid endarterectomy. 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 attack.

  • Angioplasty. 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.

  • Other techniques. 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.

Preventive medications. 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 include:

  • Anti-platelet drugs. 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).

  • Anticoagulants. 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.

Hemorrhagic stroke
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:

  • Aneurysm clipping. 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.

  • Coiling (aneurysm embolization). 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.

  • Surgical AVM removal. 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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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
In no event will The DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.

 


 



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