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 lifesaving treatment on the way to the emergency room. During a stroke, every minute counts.
Once you receive immediate treatment, your doctor will try to treat your stroke risk factors and prevent complications by recommending heart-healthy lifestyle changes.
Treating an Ischemic Stroke or 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.
If you have a stroke caused by a blood clot, you may be given a clot-dissolving, or clot-busting, medication called tissue plasminogen activator (tPA). A doctor will inject tPA into a vein in your arm. This type of medication must be given within 4 hours of symptom onset. Ideally, it should be given as soon as possible. The sooner treatment begins, the better your chances of recovery. Thus, it’s important to know the signs and symptoms of a stroke and to call 9–1–1 right away for emergency care.
If you can’t have tPA for medical reasons, your doctor may give you antiplatelet medicine that helps stop platelets from clumping together to form blood clots or anticoagulant medicine (blood thinner) that keeps existing blood clots from getting larger. Two common medicines are aspirin and clopidogrel.
Researchers are testing other treatments for ischemic stroke, such as intra-arterial thrombolysis and mechanical clot 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 a Hemorrhagic Stroke
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures. 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 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, 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:
- Injecting a substance into the blood vessels of the AVM to block blood flow
- Surgery to remove the AVM
- 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 heart-healthy lifestyle changes to help control your risk factors.
- heart-healthy eating
- maintaining a healthy weight
- managing stress
- physical activity
- quitting smoking
If lifestyle changes aren’t enough, you may need medicine to control your risk factors.
Your doctor may recommend heart-healthy eating, which should include:
- Fat-free or low-fat dairy products, such as skim milk
- Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week
- Fruits, such as apples, bananas, oranges, pears, and prunes
- Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
- Vegetables, such as broccoli, cabbage, and carrots
- Whole grains, such as oatmeal, brown rice, and corn tortillas
When following a heart-healthy diet, you should avoid eating:
- A lot of red meat
- Palm and coconut oils
- Sugary foods and beverages
Two nutrients in your diet make blood cholesterol levels rise:
- Saturated fat—found mostly in foods that come from animals
- Trans fat (trans fatty acids)—found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats.
Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples:
|If you eat:||Try to eat no more than:|
1,200 calories a day
8 grams of saturated fat a day
1,500 calories a day
10 grams of saturated fat a day
1,800 calories a day
12 grams of saturated fat a day
2,000 calories a day
13 grams of saturated fat a day
2,500 calories a day
17 grams of saturated fat a day
Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are:
- Corn, sunflower, and soybean oils
- Nuts and seeds, such as walnuts
- Olive, canola, peanut, safflower, and sesame oils
- Peanut butter
- Salmon and trout
Try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and “no added salt” foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more.
Dietary Approaches to Stop Hypertension
Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt.
The DASH eating plan is a good heart-healthy eating plan, even for those who don’t have high blood pressure. Read more about DASH.
Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain.
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is:
- 12 ounces of beer
- 5 ounces of wine
- 1½ ounces of liquor
Knowing your body mass index (BMI) helps you find out if you’re a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institute’s (NHLBI) online BMI calculator or talk to your doctor. A BMI:
- Below 18.5 is a sign that you are underweight.
- Between 18.5 and 24.9 is in the normal range.
- Between 25.0 and 29.9 is considered overweight.
- Of 30.0 or higher is considered obese.
A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal.
Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk.
If you’re overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol.
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as:
- A stress management program
- Physical activity
- Relaxation therapy
- Talking things out with friends or family
Regular physical activity can lower many risk factors for stroke.
Everyone should try to participate in moderate-intensity aerobic exercise at least 2 hours and 30 minutes per week or vigorous aerobic exercise for 1 hour and 15 minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10 minutes at a time spread throughout the week.
Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you.
Read more about physical activity at:
- Physical Activity and Your Heart
- U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans
If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for stroke. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
For more information about how to quit smoking, visit Smoking and Your Heart.