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 or carotid artery angioplasty. Both procedures open blocked carotid arteries.
Researchers are testing other treatments for ischemic stroke, such as intra-arterial thrombolysis 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, and arteriovenous malformation (AVM) repair.
Neuroprotectants are medications or other treatments that protect the brain from secondary injury caused by stroke. Although the FDA (Food and Drug Administration) has not approved any neuroprotectants for use in stroke at this time, many have been tested or are being tested in clinical trials.
Reference: National Heart Lung and Blood Institute (NHLBI)