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Stroke

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The key to successful treatment of stroke is getting treatment as soon as possible. It is essential that you seek immediate medical help as soon as you recognize any substantial symptoms of stroke in yourself or someone you are with. The quicker you can get a stroke patient to medical care, the better that patient's chances are of recovery and minimal brain damage. The type of stroke that has occurred, and the length of time between when the stroke occurred and when treatment can begin will determine which treatments doctors can use and how effective those treatments are likely to be.

Different sorts of damage to the cerebral arteries cause ischemic and hemorrhagic strokes. Treatment for each type of stroke necessarily must address the type of stroke damage that has occurred if it is to be effective.

Ischemic stroke is caused by a blockage in an artery supplying blood to the brain. The goal of treatments for ischemic stroke is to remove that blockage and restore blood flow to the brain as quickly as possible. Doctors may use one or more of the following techniques in the service of this goal:

  • "Clot Buster" Medications. Clot busting drugs (otherwise known as “thrombolytics”) work to dissolve blood clots that can block arteries causing stroke. Though thrombolytic drugs are one of the most effective treatments for ischemic stroke available, they must be administered within three hours of the onset of stoke symptoms if they are to do any good. Unfortunately, most stroke patients don't recognize the seriousness of their conditions and do not get medical care within this three hour window of effectiveness. Doctors must be absolutely certain that the stroke they are treating is ischemic (rather than hemorrhagic) in nature before they administer thrombolytic drugs, because the drugs may worsen internal bleeding.

  • Anti-platelet Medications. Anti-platelet drugs decrease the activity of platelets in the blood stream making it harder for a patient's blood to clot. Commonly prescribed anti-platelet drugs include aspirin and ticlopidine. These drugs are primarily used to prevent the onset of stroke.

  • Carotid Endarterectomy. During this procedure a doctor surgically removes a blockage from the carotid artery (located in the neck) that supplies the majority of the blood to the brain. This procedure is very effective in restoring blood flow to the brain in the short term. However, arteriosclerotic plaques commonly build up in the same area again, necessitating further treatment. Generally, carotid endarterectomy patients must remain in the hospital laying flat on a bed with their neck movements restricted for two days after their operation.

  • Angioplasty. During this procedure a doctor inserts a catheter (a thin tube) into the body and maneuvers it so that the tip of the catheter is at the area of arterial blockage. The doctor then inflates a small balloon located at the catheter's tip causing the artery to stretch, dislodging blockage or smashing it down against the vessel wall. Occasionally, the doctor may implant a small metal screen known as a stent into the artery to keep it held open. Angioplasty is often very successful, lessening blood flow blockage symptoms substantially in about 90% of cases. However, as with carotid endarterectomy, arteriosclerotic plaques often recur and further treatment is necessary approximately 20% of the time. Angioplasty is often performed as day surgery, with patients returning home the same night they were operated on. However, on occasion, a hospital recovery is required. Patients generally recover from angioplasty within a week of their surgery.

  • Bypass Surgery. When arterial blockage cannot be safely removed, doctors may order a bypass operation to occur. During this procedure doctors take a portion of healthy artery from another part of the body and graft it around the blockage in a manner that allows the blood to flow around the blocked area. More commonly associated with heart disease these days, this procedure is not widely used for stroke anymore. When they do occur, bypass surgeries are often very successful in reducing blood flow blockage symptoms. As with any bypass operation, patients recover in the hospital for a week or so, spending the first several days in the intensive care unit where their cardiovascular function is closely monitored to ensure that the graft is working effectively. Patients generally recover a month or so after the procedure.

Unlike Ischemic stroke, Hemorrhagic stroke occurs when an artery in the brain ruptures, spilling blood into the brain. Though blood is necessary to keep the brain functioning, it is toxic to the brain when it is not contained by the blood vessels. The goal of hemorrhagic stroke treatment is to seal off the ruptured artery to prevent further blood loss, and to prevent uncontained blood from contacting brain tissue. Doctors use the following techniques in the service of these goals:

  • Surgery. In most instances surgery will be necessary in the treatment of a hemorrhagic stroke. The goal of the surgery will be to block off and seal the ruptured artery. This is usually accomplished by placing metal clips on the affected artery so as to pinch off the areas immediately adjacent to the rupture.

  • Endovascular Treatment. In this preventative procedure doctors insert a catheter into a major artery (usually the femoral artery in the leg) and then runs that catheter through the artery system up to the affected area in the brain at risk for rupture. Using the catheter they insert a stabilizer, normally in the shape of a coil, into the artery to stabilizer the arterial wall, making a rupture less likely. Endovascular treatment is a much less invasive procedure than hemorrhagic surgery, but it is only useful as a preventative measure.

 

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