Home > Medical Specialties, Centers and Clinics > Stroke Center > Acute Treatment

Acute Treatment of Stroke

Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Types of Treatment for Stroke

Figure 1. Ralph was treated with tPA
at Barrow.

Thrombolytic therapy is available for the 85% of strokes that are caused when a blood vessel in the brain is blocked by a clot (ischemic stroke). A substance called tPA (tissue plasminogen activator) is administered intravenously during the first three hours after the stroke. By dissolving the blood clot, tPA restores blood flow to the brain and significantly improves a patient's chances of recovery. This medication is called a thrombolytic drug because it helps to dissolve (lyse) blood clots (thrombi) that are blocking blood flow to the brain.

Figure 2. Carotid stenting, the guide wire is placed in the internal carotid
artery, a stent is deployed and the angioplasty balloon expands the
diameter of the stent and artery wall.

Surgery and endovascular therapy are used to treat patients diagnosed with a hemorrhagic stroke. Surgery may be needed to remove blood from the brain and to place a temporary drainage catheter to reduce pressure within the brain. If an aneurysm is found, treatment is either surgery to clip it or endovascular intervention to fill it with tiny platinum coils to prevent further bleeding.

When blood flow through the carotid artery is significantly reduced, surgery (carotid endarterectomy) is recommended to remove the plaque and to restore blood flow. Plaque in the vertebral arteries, and even in arteries within the brain, can sometimes be treated surgically or with balloon angioplasty and stenting (as is done with arteries of the heart).

These procedures open arteries that are narrowed by plaque and improve the blood flow to the brain. Although balloon angioplasty and stenting are under scientific evaluation, they are available to patients who meet special criteria. See Fig. 2.

General Medical Considerations

General medical treatment depends on the cause of the stroke, the length of time from the beginning of symptoms, and the patient's overall health. Important health issues that must be considered include the following:

Blood pressure control
Fluid administration
Hyperthermia (fever) control
Glucose (blood sugar) control
Nutrition maintenance
Aspiration prevention (reduce risk of fluid entering the lungs)
Deep venous thrombosis (blood clots in the legs) prevention