Treatment Options for Ischemic and Hemorrhagic Stroke
Treatment for stroke depends on whether you’re having an ischemic stroke or a hemorrhagic stroke. It is important to know since the early treatment of both is different.
Ischemic Stroke Treatment
The goal of Ischemic stroke treatment is to dissolve and remove a blood clot that blocks the blood flow to the brain. The most common treatments for ischemic stroke include:
Intravenous injection of tissue Plasminogen Activator (tPA)
This is the first-choice treatment for ischemic stroke. tPA is usually injected into the bloodstream through an intravenous line. This drug travels in the blood until it reaches the clot causing a stroke. Once there, it began to break down the blood clots until blood can flow pass toward it to the brain.
To work properly and safely, tPA should be given within 3 hours after first symptoms started. This because, the sooner tPA is given, the better it works. Before you can get tPA, you need to be tested to make sure you’re not having a hemorrhagic stroke because tPA can make hemorrhagic strokes worse.
A stent retriever is a medical device that looks like a small metal cage attached to the end of a long wire. They thread a catheter through an artery in the groin up to the blocked artery in the brain. The stent opens and remove the clot that cause a stroke.
Stent retrievers are often used in combination with tissue plasminogen activator (tPA) treatment, consists of using a protein to break down blood clots. Unfortunately, tPA treatment on its own is only successful for about a third of patients.
Hemorrhagic Stroke Treatment
Treatment of hemorrhagic stroke varies depending on the cause of the bleeding (such as high blood pressure, use of anticoagulant medications, head trauma, blood vessel malformation)
The goal of treatment is to find the cause of bleeding and control it to prevent complications such as permanent brain damage.
Medical management of Hemorrhagic strokes
Some medications are given to minimize the risk of complications, including:
- Blood pressure medication to prevent rebleeding.
- Anticonvulsants, medication against seizures.
- Certain diuretics to decrease the pressure in the subarachnoid space inside the head.
Surgical treatment for Hemorrhagic strokes
Surgical treatments vary depending on the cause of the stroke.
High blood pressure (hypertension)
High blood pressure is one of the main causes of bleeding within the brain tissue. The surgical approach is a craniotomy, where the surgeon creates an opening in the skull and gains access to the aneurysm. Then, they place a clip on the aneurysm’s opening to obstruct blood flowing into the aneurysm.
Aneurysms are balloon-like bulges in a blood vessel caused by weakening of the artery wall. Surgery for aneurysms involves either surgical clipping or endovascular coiling.
- Clipping/open brain surgery (craniotomy) – Surgeons perform a craniotomy to create an opening in the skull and gain access to the aneurysm. Then, they place a clip on the aneurysm’s opening to obstruct blood flowing into the aneurysm.
- Endovascular repair (using coils/coiling and stents) – A minimally invasive technique using a catheter to reach the aneurysm and then coils to induce clotting and prevent blood flow from entering it.
Arteriovenous malformations (AVMs)
Arteriovenous malformations are abnormal connection between the arteries and veins in the brain that usually forms before birth. Treatments include:
- Open brain surgery – Procedure to remove the abnormal connection through an opening in the skull.
- Embolization – An alternative to open surgery, the procedure uses a catheter and then a glue-like substance to cut off blood supply.
- Gamma knife surgery – During this noninvasive procedure, radiation is aimed at the arteriovenous malformation, causing scarring and shrinkage, and reducing the risk of bleeding.