Stroke

Treatment

Whether ischemic or hemorrhagic, stroke is treated in three stages: prevention, medication and surgery, and rehabilitation. Treatment differs for each type of stroke, however.

Prevention

Therapies to prevent stroke are based on treating an individual's underlying risk factors. They include medications, surgical intervention and angioplasty and stenting (surgical/endovascular treatment).

Ischemic stroke prevention usually involves medication-based treatment for risk factors, drugs to prevent blood clot formation, or surgical or endovascular treatments for narrowed arteries.

Hemorrhagic stroke prevention generally focuses on medication-based treatment for risk factors and, in some cases, surgical/endovascular treatment for potential causes of hemorrhage (such as aneurysm or vascular malformations).

Medications for 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). They are anticoagulants such as heparin and warfarin and antiplatelet agents such as aspirin, clopidogrel and dipyridamole.

Anticoagulants thin the blood and prevent clotting. Heparin acts quickly and is given intravenously (through a vein) or subcutaneously (beneath the skin) while a patient is in the hospital. Slower-acting warfarin can be given orally and is used over a longer term. These drugs affect the blood's ability to clot and require close monitoring by a physician.

Antiplatelet drugs prevent platelet aggregation. Platelets are specialized cells in the blood that initiate a healing process. Large numbers of platelets aggregate (clump together) to form a clot, which can sometimes block an artery or break loose, travel through the bloodstream, 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 TIA or prior ischemic stroke.

Pharmacological and mechanical clot busters are used for severe, acute ischemic strokes. They are most commonly given intravenously. At Mayo Clinic, specialists may also provide intra-arterial thrombolytic therapy (inject clot busters directly into an artery) and/or mechanical clot disrupting or clot extraction devices, which are also delivered directly into a blocked artery.

Surgery, Endovascular Treatments and Other Procedures

The type of surgery that may be required depends on the type of stroke. Mayo Clinic neurologists, neurosurgeons, neuroradiologists, endovascular surgical neuroradiologists, cardiologists, vascular surgeons and other specialists carefully consider all management options and determine the most appropriate treatment for each stroke patient. Physical medicine and rehabilitation specialists 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) and hemorrhagic stroke.

Rehabilitation

The primary objective of rehabilitation after stroke is to provide the environment that best directs the brain's processes toward recovery. Stroke can cause difficulties in many aspects of life, so rehabilitation often requires specialists from many different disciplines.

Read more about rehabilitation.