Stroke

Treatment

The two main types of stroke are treated differently.

Prevention

Therapies to prevent stroke are based on treating an individual's underlying risk factors and include medications, surgical intervention and angioplasty/stenting (endovascular treatment). Ischemic stroke prevention usually involves medication treatment for risk factors, drugs to prevent blood clots from forming, or surgical or endovascular treatments for narrowed arteries. Hemorrhagic stroke prevention generally focuses on medication treatment for risk factors, and in some cases surgical/endovascular treatment for certain potential causes of hemorrhage (such as aneurysm or vascular malformations).

Mayo Clinic has a unique ability to find the cause of the stroke through a team approach that brings together specialists from many areas. Working together with the patient, the Mayo Clinic team of specialists tailors each patient's treatment to what caused the stroke and agressively controls risk factors in an effort to prevent further strokes.

Medications used in ischemic stroke

Two broad categories of medications are available to help prevent stroke in high-risk patients, especially those who have had a previous TIA or ischemic stroke: anticoagulants such as heparin and warfarin (Coumadin) and antiplatelet agents (such as aspirin, clopidogrel and dipyridamole).

Anticoagulants thin the blood and prevent clotting. They are also used for deep vein thromboses and pulmonary (lung) emboli. Heparin is acts quickly and is given intravenously or subcutaneously while a patient is in the hospital. Slower-acting warfarin can be given orally and is used over a longer term. These drugs profoundly affect blood clotting and require close monitoring by a physician.

Antiplatelet drugs work by preventing platelet aggregation. Platelets are specialized cells in the blood that initiate a healing process. Large numbers of platelets clump together (aggregate) and form a clot, which can sometimes block an artery or break loose and block a smaller artery. Antiplatelet drugs make platelets less sticky and less likely to form clots, reducing the risk of ischemic stroke in patients who have had TIAs or prior ischemic strokes.

Clot busters are used in certain, severe acute ischemic strokes. They are most commonly given intravenously. Some medical centers, including Mayo Clinic, can also give clot busters directly into the artery, called intra-arterial thrombolytic therapy.

Surgery, endovascular treatments and other procedures

The type of surgery that may be required depends on the type of stroke the patient has had. Mayo Clinic neurologists, neurosurgeons, neuroradiologists, cardiologists and other specialists will carefully consider all management options, recommending a procedure when indicated. Physical medicine and rehabilitation specialists will also initiate any therapies that may improve a lasting disability.

For information about surgical options and other procedures, see:

• Ischemic stroke and Transient ischemic attack (TIA)
• Hemorrhagic stroke

Rehabilitation after stroke

Stroke can cause difficulties in many aspects of life and rehabilitation efforts often require clinicians from many different disciplines. The primary objective of rehabilitation after stroke is to provide the environment and experience that best directs the restorative processes in the brain along the continuum of recovery. Read more about rehabilitation.