Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions.
Strokes and TIAs are medical emergencies. If you have stroke symptoms, call 9–1–1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
Once you receive initial treatment, your doctor will try to treat your stroke risk factors and prevent complications.
Treating Ischemic Stroke and Transient Ischemic Attack
An ischemic stroke or TIA occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Often, blood clots cause the blockages that lead to ischemic strokes and TIAs.
Treatment for an ischemic stroke or TIA may include medicines and medical procedures.
A medicine called tissue plasminogen activator (tPA) can break up blood clots in the arteries of the brain. A doctor will inject tPA into a vein in your arm. This medicine must be given within 4 hours of the start of symptoms to work. Ideally, it should be given as soon as possible.
If, for medical reasons, your doctor can’t give you tPA, you may get an antiplatelet medicine. For example, aspirin may be given within 48 hours of a stroke. Antiplatelet medicines help stop platelets from clumping together to form blood clots.
Your doctor also may prescribe anticoagulants, or “blood thinners.” These medicines can keep blood clots from getting larger and prevent new blood clots from forming.
If you have carotid artery disease, your doctor may recommend a carotid endarterectomy (END-ar-ter-EK-to-me) or carotid artery percutaneous (per-ku-TA-ne-us) coronary intervention, sometimes referred to as angioplasty (AN-jee-oh-plas-tee). Both procedures open blocked carotid arteries.
Researchers are testing other treatments for ischemic stroke, such as intra-arterial thrombolysis (throm-BOL-ih-sis) and mechanical clot (embolus) removal in cerebral ischemia (MERCI).
In intra-arterial thrombolysis, a long flexible tube called a catheter is put into your groin (upper thigh) and threaded to the tiny arteries of the brain. Your doctor can deliver medicine through this catheter to break up a blood clot in the brain.
MERCI is a device that can remove blood clots from an artery. During the procedure, a catheter is threaded through a carotid artery to the affected artery in the brain. The device is then used to pull the blood clot out through the catheter.
Treating Hemorrhagic Stroke
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it.
Unlike ischemic strokes, hemorrhagic strokes aren’t treated with antiplatelet medicines and blood thinners. This is because these medicines can make bleeding worse.
If you’re taking antiplatelet medicines or blood thinners and have a hemorrhagic stroke, you’ll be taken off the medicine.
If high blood pressure is the cause of bleeding in the brain, your doctor may prescribe medicines to lower your blood pressure. This can help prevent further bleeding.
Surgery also may be needed to treat a hemorrhagic stroke. The types of surgery used include aneurysm clipping, coil embolization (EM-bol-ih-ZA-shun), and arteriovenous malformation (AVM) repair.
Aneurysm Clipping and Coil Embolization
If an aneurysm (a balloon-like bulge in an artery) is the cause of a stroke, your doctor may recommend aneurysm clipping or coil embolization.
Aneurysm clipping is done to block off the aneurysm from the blood vessels in the brain. This surgery helps prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.
During the procedure, a surgeon will make an incision (cut) in the brain and place a tiny clamp at the base of the aneurysm. You’ll be given medicine to make you sleep during the surgery. After the surgery, you’ll need to stay in the hospital’s intensive care unit for a few days.
Coil embolization is a less complex procedure for treating an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the site of the aneurysm.
Then, a tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from bursting again.
Coil embolization is done in a hospital. You’ll be given medicine to make you sleep during the surgery.
Arteriovenous Malformation Repair
If an AVM is the cause of a stroke, your doctor may recommend an AVM repair. (An AVM is a tangle of faulty arteries and veins that can rupture within the brain.) AVM repair helps prevent further bleeding in the brain.
Doctors use several methods to repair AVMs. These methods include:
- Surgery to remove the AVM
- Injecting a substance into the blood vessels of the AVM to block blood flow
- Using radiation to shrink the blood vessels of the AVM
Treating Stroke Risk Factors
After initial treatment for a stroke or TIA, your doctor will treat your risk factors. He or she may recommend lifestyle changes to help control your risk factors.
Lifestyle changes may include quitting smoking, following a healthy diet, maintaining a healthy weight, and being physically active.
If lifestyle changes aren’t enough, you may need medicine to control your risk factors.
If you smoke or use tobacco, quit. Smoking can damage your blood vessels and raise your risk of stroke and other health problems. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. Secondhand smoke also can damage the blood vessels.
For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s (NHLBI’s) "Your Guide to a Healthy Heart." Although these resources focus on heart health, they include general information about how to quit smoking.
The U.S. Department of Health and Human Services (HHS) also has information about how to quit smoking.
Following a Healthy Diet
A healthy diet is an important part of a healthy lifestyle. Choose a variety of fruits, vegetables, and grains; half of your grains should come from whole-grain products.
Choose foods that are low in saturated fat, trans fat, and cholesterol. Healthy choices include lean meats, poultry without skin, fish, beans, and fat-free or low-fat milk and milk products.
Choose and prepare foods with little sodium (salt). Too much salt can raise your risk of high blood pressure. Studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure.
Choose foods and beverages that are low in added sugar. If you drink alcoholic beverages, do so in moderation.
For more information about following a healthy diet, go to the NHLBI’s Aim for a Healthy Weight Web site, “Your Guide to a Healthy Heart,” and “Your Guide to Lowering Your Blood Pressure With DASH.” All of these resources provide general information about healthy eating.
Maintaining a Healthy Weight
Maintaining a healthy weight can lower your risk of stroke. A general goal to aim for is a body mass index (BMI) of less than 25.
BMI measures your weight in relation to your height and gives an estimate of your total body fat. You can measure your BMI using the NHLBI's online calculator, or your health care provider can measure your BMI.
A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing a stroke.
For more information about losing weight and maintaining your weight, go to the HEALTH TOPICS Overweight and Obesity article.
Being Physically Active
Regular physical activity can help control many stroke risk factors, such as high blood pressure, unhealthy cholesterol levels, and excess weight.
Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.
People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.
For more information about physical activity, go to the HHS’ "2008 Physical Activity Guidelines for Americans," the HEALTH TOPICS Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."
Although the HEALTH TOPICS article and “Your Guide” booklet focus on heart health, they include information that applies to general health and well-being.