Mayo Clinic's highly specialized stroke experts will quickly review your test results and determine the best treatment option(s) for you. One way to evaluate quality stroke care is to look at the percentage of patients receiving timely and effective care measures that are appropriate. At all Mayo Clinic campuses, the percentage of eligible Mayo Clinic patients diagnosed with stroke who receive all the appropriate care measures is above the national average.
Emergency treatment for stroke depends on whether you're having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke that involves bleeding into the brain.
To treat an ischemic stroke, your Mayo Clinic stroke care team must quickly restore blood flow to your brain.
Emergency treatment with medications. Therapy with clot-busting drugs must start within 3 to 4.5 hours if they're given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given:
- Aspirin. Aspirin is an immediate treatment given in the emergency room to reduce the likelihood of having another stroke. Aspirin prevents blood clots from forming.
Intravenous injection of tissue plasminogen activator (TPA). Some people can benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called alteplase. An injection of TPA is usually given through a vein in the arm. This potent clot-busting drug needs to be given within 3 to 4.5 hours after stroke symptoms begin if it's given in the vein.
TPA restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if TPA is appropriate for you.
Emergency procedures. Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible, depending on features of the blood clot:
- Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain, and then release TPA directly into the area where the stroke is occurring. The time window for this treatment is somewhat longer than for intravenous TPA but is still limited.
Minimally invasive mechanical clot removal. Doctors may use a catheter to maneuver a tiny device into your brain to physically break up or grab and remove the clot.
However, recent studies suggest that delivering medication directly to the brain (intra-arterial thrombolysis) or using a device to break up or remove clots (mechanical thrombectomy) may not be beneficial for most people. Mayo Clinic scientists are working to determine who might benefit from this procedure.
Other procedures. To decrease your risk of having another stroke or transient ischemic attack (ministroke), your doctor may recommend a procedure to open up an artery that's narrowed by fatty deposits (plaques).
If surgery is the most appropriate treatment, you want to be in the hands of experienced surgeons who perform these operations frequently. Neurosurgery is among the most complex of the surgical disciplines. At Mayo Clinic, experienced vascular neurosurgeons perform more than 100 procedures for stroke and other cerebrovascular conditions each year. Options will vary depending on your situation and may include:
Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery and removes plaques that block the carotid artery.
Your surgeon then repairs the artery with stitches or a patch made from a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
Angioplasty and stents. In an angioplasty, a surgeon inserts a catheter with a mesh tube (stent) and balloon on the tip into an artery in your groin and guides the catheter to the blocked carotid artery in your neck. Your surgeon inflates the balloon in the narrowed artery and inserts a mesh tube (stent) into the opening to keep your artery from narrowing after the procedure.
Mayo Clinic monitors and shares quality data relating to carotid endarterectomy and carotid stenting, consistently demonstrating low mortality rates for these procedures.
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures, causing bleeding in the brain. For emergency treatment of hemorrhagic stroke, your Mayo Clinic stroke care team will focus on controlling your bleeding and reducing pressure in your brain. Surgery also may be performed to help reduce future risk.
Emergency measures. If you take warfarin (Coumadin) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract these blood thinners' effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures.
Once the bleeding in your brain stops, treatment focuses on supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain.
Surgical blood vessel repair. Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM) or other type of vascular malformation caused your hemorrhagic stroke. Mayo Clinic vascular neurosurgeons are experienced in determining and performing the most effective procedures using the latest minimally invasive surgical techniques.
- Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
- Coiling (endovascular embolization). In this procedure, a surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Your surgeon then guides tiny detachable coils into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot.
- Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if it's large or located deep within your brain.
- Intracranial bypass. In some unique circumstances, surgical bypass of intracranial blood vessels may be an option to treat poor blood flow to a region of the brain or complex vascular lesions, such as aneurysm repair.
- Stereotactic radiosurgery. Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair vascular malformations.
Stroke recovery and rehabilitation
Following emergency treatment, stroke care focuses on helping you regain your strength, recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged.
If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders.
In addition, if you've had a stroke, you may have problems with breathing, swallowing, balance and vision.
Most stroke survivors receive treatment in a rehabilitation program. At Mayo Clinic, your subspecialized care team will include experts trained in physical medicine and rehabilitation to offer a full range of brain rehabilitation treatment options for you, from intensive hospital care to outpatient and community-based services. Depending on your condition, your care team may also include:
- Doctor trained in brain conditions (neurologist)
- Rehabilitation doctor (physiatrist)
- Physical therapist
- Occupational therapist
- Recreational therapist
- Speech therapist
- Social worker
- Case manager
- Psychologist or psychiatrist
Your subspecialized team will recommend the most rigorous therapy program you can handle based on your age, overall health and your degree of disability from your stroke. Your care team will also work with you to take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers.
Your rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.
Potential future treatments
Mayo Clinic scientists are constantly seeking new medical knowledge and individual-driven innovation for people who have had a stroke or are at risk of stroke. Active research studies include causes, risk factors, prevention, diagnostic tests and treatment options, including improvements to microcoil technology. A variety of clinical trials and other clinical studies may be available to you at Mayo Clinic.
Nov. 22, 2014
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