Treatment
Treatment for Transient Ischemic Attack
Treatment for Ischemic Stroke
Treatment for Hemorrhagic Stroke

Transient Ischemic Attack

Ischemic Stroke
The best emergency treatment for an ischemic stroke without secondary hemorrhage is

  • tPA — a clot buster that breaks up the clot,
  • or the Merci Retriever — a corkscrew like device that breaks though or retrieves the clot or embolus

Hemorrhagic Stroke

Treatment for a Hemorrhagic stroke is based on the underlying cause of the hemorrhage and the extent of damage to the brain. Immediate treatment may include lifesaving measures, surgery to control/repair cause of bleeding or just relief of symptoms.

Medications

  • If high blood pressure is high, antihypertensive drugs are administered to bring blood pressure down.
  • Swelling of brain may be reduced or controlled with hyperosmotic agents (mannitol, glycerol, and hypertonic saline solutions).
  • If the hemorrhage resulted from the use of anticoagulants, Coumadin or heparin, medications may be given to reverse the effects of these anticoagulants to reduce bleeding.
  • Pain relievers and antianxiety medications may relieve the headache that often accompanies hemorrhagic stroke.
  • Medications may be needed to prevent or treat seizures.

Surgery

Generally there are 3 types of surgeries for hemorrhagic stroke.

Surgery for Aneurysm:

  • Aneurysm clipping involves opening the skull to expose the aneurysm and placing a clip to prevent future leaking of blood from the affected artery. The goal of surgery for subarachnoid bleeding is to reduce the chances of a second bleed from an aneurysm, which is often fatal.
  • Endovascular treatment of aneurysms. In this procedure, a radiologist passes a catheter (thin tube) through the artery to the opening into an aneurysm. Detachable platinum coils are then deposited in the aneurysm to fill it up and prevent blood from entering, eliminating the possibility of hemorrhage. Other endovascular treatments for aneurysms are being evaluated.

AVM Treatment:

  • Surgical arteriovenous malformation removal . It is not always possible to remove an arteriovenous malformation (AVM) if it is too large or located deep within the brain. Surgical removal of a smaller AVM from a more accessible portion of the brain can eliminate the risk of AVM rupture. Stereotactic microsurgery, using sophisticated computer technology, cameras and delicate instruments may be used to remove arteriovenous malformations.
  • Stereotactic radiosurgery. Stereotactic radiosurgery may be used to obliterate AVMs. This procedure focuses a beam of radiation on the AVM, causing it to clot and eventually disappear.
  • Endovascular treatment (coil embolization) of AVMs. This procedure is similar to the treatment for aneurysms. A catheter is inserted into a leg artery and threaded through the body to the brain arteries. The catheter is positioned in one of the feeding arteries to the AVM, and coils, small particles or a gluelike substance is injected to block the vessel and reduce the blood flow into the AVM. In some large AVMs that appear “inoperable,” embolization makes the AVM smaller, allowing it to be treated with surgery or radiosurgery.
  • In rare cases, endovascular embolization may obliterate or cure the AVM, eliminating the need for other therapy.
  • General Hemorrhage Treatments
    • Removal of hematoma: Removal of a hematoma (a collection of blood, usually clotted, resulting from a break in the wall of a blood vessel) may be needed, especially when bleeding occurs in the back of the brain. Some physicians are investigating whether the injection of a clot busting drug inside the hematoma can help with the removal of brain hemorrhages through needles or catheters, therefore allowing less invasive surgery.
    • Ventriculostomy: A procedure called ventriculostomy may be performed if fluid accumulates due to bleeding in the brain and needs to be drained.

 

Related Information:
Stroke Treatments and drugs, Mayo Clinic
Current Status of Hemorrhagic Stroke and Acute Nonthrombolytic Ischemic Stroke Treatment