Once a stroke happens, the time to treatment is the most critical factor for survival and recovery.
Treatments may include hospital emergency response and followup care, medicines, percutaneous interventions, surgery, and rehabilitation. Treatment Options
Medicines for stroke can vary. Those that help one kind of stroke may actually increase the damage caused by another kind of stroke. For example, clot-dissolving medicines may help treat an ischemic stroke (a stroke caused by a blood clot), but they may increase the damage caused by a hemorrhagic (bleeding) stroke by causing bleeding in the brain.
Tissue plasminogen activator (t-PA) is a clot-dissolving medicine approved for use by the U.S. Food and Drug Administration. This medicine is a major breakthrough in the treatment of stroke caused by blood clots, which make up 87% of all strokes. Doctors cannot use t-PA for every stroke patient (it may cause bleeding in the brain), but t-PA has been found to help ischemic stroke patients when given within 3 hours of the start of stroke symptoms.
When you get to the hospital after having a stroke, doctors may give you anticoagulants (warfarin) orantiplatelet drugs (aspirin, ticlopidine, clopidogrel) to prevent another blood clot from forming. You may be given a pain reliever if you have a severe headache.
Your blood pressure may rise during a stroke, because your body tries to make up for the decreased blood flow to your brain. For this reason, lowering your blood pressure right after a stroke may not be recommended, especially in patients with chronic high blood pressure (their autoregulation of blood flow to the brain is different from people without high blood pressure).
For some patients, other treatments may include
- Medications to control high blood pressure
- Insulin regulation for people with diabetes
- Statins or other cholesterol-lowering medicines to reduce high cholesterol levels.
Controlling such risk factors through changes in lifestyle may prevent another stroke.
Often, a form of heart disease brings on a stroke. In those cases, doctors will treat the cause of the heart disease. For example, damaged heart valves may need to be surgically repaired or replaced. Patients withatrial fibrillation, a type of arrhythmia, may need to take blood-thinning medicines (anticoagulants) to stop blood clots from forming. Oral anticoagulants (pills that you swallow) and aspirin appear to decrease the risk of stroke among patients with atrial fibrillation.
Carotid endarterectomy is a surgical procedure that removes fatty buildup (atherosclerotic plaque) in a neck artery that supplies oxygen-rich blood to the brain. The procedure may help patients who have had a stroke, but surgeons have to wait at least 6 weeks after the stroke before considering surgery. Carotid endarterectomy may also be used to prevent a stroke in people who have the fatty buildup that may cause a stroke. Doppler ultrasound can be used to find out how much buildup is in the artery and when a carotid endarterectomy may be performed to help prevent a stroke.
Carotid artery angioplasty is a procedure during which interventional cardiologists, radiologists or vascular surgeons open the clogged arteries in your neck to prevent or treat stroke. They use a long, thin tube called a catheter that has a small balloon on its tip. They inflate the balloon at the blockage site in the carotid artery to flatten or compress the plaque against the artery wall. Carotid angioplasty is often combined with the placement of a small, metal, mesh-like device called a stent. Carotid angioplasty and stenting are usually performed in patients either because they are not candidates for the traditional surgery (carotid endarterectomy) or because the procedure is felt to be less risky than the traditional surgery.
Stroke is a leading cause of long-term disability in the United States. Stroke survivors face a variety of mental and physical challenges, depending on how severely their brains were affected. With rehabilitation, most stroke survivors can improve their quality of life.
Rehabilitation helps survivors reduce their dependence on caregivers and improve physical ability. The keys to successful rehabilitation include the attitude of the survivor, the skill of the rehabilitation team, and the encouragement and cooperation of family and friends.
According to the National Stroke Association, rehabilitation options vary depending on the severity of the stroke. They may include
- A hospital rehabilitation unit.
- A rehabilitation hospital.
- Home therapy.
- Outpatient therapy.
- A long-term care facility that provides therapy and skilled nursing care.
Survivors of stroke need a supportive network to help them though rehabilitation. Stroke support groups or clubs provide excellent opportunities to meet with medical experts and other survivors and their families. These clubs are also places to learn, share, and encourage.