A stroke requires emergency care. You will probably receive treatment in a specialized stroke unit of the hospital. A team of specialists will oversee your care. Treatment will depend on whether the stroke was ischemic or hemorrhagic, how much time has passed since symptoms began, and whether you have other medical conditions.
Treating an ischemic stroke
Treatment for an ischemic stroke or transient ischemic (TIA) may include medicines and medical procedures.
The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA). It breaks up the blood clots that block blood flow to your brain. A doctor will inject tPA into a vein in your arm. This type of medicine must be given within 3 hours after your symptoms start. In some cases, it is given up to 4.5 hours. The sooner treatment begins, the better your chances of recovery.
If you cannot have tPA, your doctor may give an anticoagulant or blood thinning medicine, such as aspirin or clopidrogrel. This helps stop blood clots from forming or getting larger. The main side effect of these medicines is bleeding.
You may need a procedure to open up blocked arteries and restore blood flow to the brain. This can be done several ways.
A thrombectomy removes the clot from the blood vessel. A surgeon will put a long, flexible tube called a catheter into your groin (upper thigh) and thread it to the blocked artery in your neck or brain. They will then use angioplasty and stenting or a device called a stent retriever to open up the blocked artery.
- Angioplasty and stenting procedures use a thin tube to deliver a balloon or small mesh tube into the artery. Inflating the balloon or expanding the mesh tube clears space for blood to flow more easily to the brain.
- The stent retriever is a wire mesh inside the catheter that traps the clot. The stent retriever and the blood clot are then pulled out through the tube.
If carotid artery disease caused your stroke, your doctor may suggest carotid endarterectomy, a surgery to remove plaque from the carotid artery in your neck.
Treating a hemorrhagic stroke
Hemorrhagic stroke can happen suddenly and grow worse quickly. Just as with an ischemic stroke, getting treatment as quickly as possible is essential for a full recovery. The type of treatment you receive depends on what part of your brain is bleeding and how severe it is.
You may be given blood pressure medicine to lower the pressure and strain on blood vessels in the brain. You will also be taken off any anticoagulant or blood-thinning medicines that may have led to bleeding. Depending on the type of medicine you were taking, you may be given vitamin K to help stop bleeding.
Procedures may include:
- Aneurysm clipping to block off the aneurysm from the blood vessels in the brain. This surgery helps stop bleeding from an aneurysm. It can also help prevent the aneurysm from bursting again. During the procedure, a surgeon places a tiny clamp at the base of the aneurysm.
- Coil embolization to block blood flow to or seal 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 aneurysm in your brain. 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.
- Blood transfusion to replace blood that is lost through surgery or injury. A blood transfusion is a common, safe medical procedure in which healthy donor blood is given to you through an intravenous (IV) line inserted in one of your blood vessels.
- Draining excess fluid that collects in the brain. Fluid can build up after a stroke, pushing the brain against the skull and causing damage. Draining the fluid can relieve that pressure.
- Surgery or radiation to remove or shrink an arteriovenous malformation (AVM). An AVM is a tangle of arteries and veins that can break open in the brain.
- Surgery to remove pooled blood. Typically, the stroke team will use surgery only if you show signs of getting worse.
- Surgery to temporarily remove part of the skull, if you have a lot of swelling. This allows room for the brain to swell without putting pressure on the brain.
Other care you may receive in the hospital
In addition to treating the blockage or bleeding causing the stroke, your healthcare team may suggest additional treatments or tests.
- Breathing support. If your stroke makes it difficult to breathe or your oxygen levels are low, you may receive ventilator support.
- Compression therapy. A sleeve can be placed on your leg and filled with air to reduce the risk of venous thromboembolism.
- Feeding tube. If it is difficult for you to swallow on your own, your team may set up a feeding tube to provide you with nutrients.
- Fluids. If you have low blood pressure or low blood volume, you may get fluids to restore proper levels.
- Medicine to reduce fever. Your team will monitor your body temperature and may give you acetaminophen or another medicine to reduce fever and prevent additional brain damage.
- Rehabilitation plan. Before you leave the hospital, your medical team will test how well you can speak, swallow, and walk. You and your medical team can work together to set up a rehabilitation plan.
- Skin care. To prevent skin irritation or sores from forming, your team will help make sure that you have enough cushioning, your skin stays dry, and that you change positions often if you cannot move well on your own.
Stroke is a life-threatening condition that can cause severe disability.or care may help some patients have a better quality of life with fewer symptoms.