With stroke, treatment depends on the stage of the disease. There are three treatment stages for stroke: prevention, therapy immediately after stroke, and rehabilitation after stroke. Stroke therapies include medications, surgery, and rehabilitation.
Medications
Medication or drug therapy is the most common treatment for stroke. The most popular kinds of drugs to prevent or treat stroke are antithrombotics -- which include antiplatelet agents and anticoagulants -- and thrombolytics.
In treating a stroke that has just occurred, every minute counts. Ischemic strokes -- the most common kind -- can be treated with thrombolytic drugs. These drugs halt the stroke by dissolving the blood clot that is blocking blood flow to the brain. But a person needs to be at the hospital as soon as possible after stroke symptoms start to be evaluated and receive treatment.
A thrombolytic drug known as t-PA can be effective if a person receives it intravenously within 3 hours after his or her stroke symptoms have started. Since thrombolytic drugs can increase bleeding,t-PA should be used only after the doctor is certain that the patient has suffered an ischemic and not a hemorrhagic stroke.
Antithrombotics prevent the formation of blood clots that can become stuck in an artery of the brain and cause strokes. Antiplatelet drugs prevent clotting by decreasing the activity of platelets, which are blood cells that help blood clot. By reducing the risk of blood clots, these drugs lower the risk of ischemic stroke.
In the case of stroke, doctors prescribe antiplatelet drugs mainly for prevention. The most widely known and used antiplatelet drug is aspirin. Other antiplatelet drugs include clopidogrel, ticlopidine, and dipyridamole.
Anticoagulants reduce the risk of stroke by reducing the clotting property of the blood. The most commonly used anticoagulants include warfarin, also known as Coumadin®, heparin, and enoxaparin, also known as Lovenox.
Neuroprotectants are medications that protect the brain from secondary injury caused by stroke. Although the Food and Drug Administration has not approved any neuroprotectants for use in stroke at this time, many are being tested in clinical trials.
There are several different types of neuroprotectants that show promise for future therapy, including glutamate antagonists, antioxidants, apoptosis inhibitors, and many others.
Surgery
Surgery can be used to prevent stroke, to treat stroke, or to repair damage to the blood vessels or malformations in and around the brain. The two most common types of surgery to prevent and treat stroke are carotid endarterectomy and extracranial/intracranial or EC/IC bypass. Extracranial refers to the area outside the cranium, or skull, and intracranial refers to the area inside the skull.
Carotid endarterectomy is a surgical procedure in which a doctor removes fatty deposits, or plaque, from the inside of one of the carotid arteries. The procedure is performed to prevent stroke. The carotid arteries are located in the neck and are the main suppliers of blood to the brain.
EC/IC bypass surgery is a procedure that restores blood flow to a blood-deprived area of brain tissue. The surgeon reroutes a healthy artery in the scalp to the area of brain tissue affected by a blocked artery.
A few years ago the National Institute of Neurological Disorders and Stroke at the National Institutes of Health sponsored a study to test the ability of EC/IC bypass surgery to prevent recurrent or additional strokes in stroke patients with atherosclerosis, or hardening of the arteries.
The study showed that, in the long run, EC/IC does not seem to benefit these patients. The surgery is still performed occasionally for patients with an aneurysm, which is a weak or thin spot that develops on the wall of an artery or vein. Sometimes, doctors also perform EC/IC bypass on patients with some types of small artery disease or certain blood vessel abnormalities.
One useful surgical procedure for treatment of brain aneurysms that can cause hemorrhage, or bleeding, is a technique called "clipping." Clipping involves clamping off the aneurysm from the blood vessel, which reduces the chance that it will burst and bleed.
The detachable coil technique is a new therapy to treat high-risk intracranial aneurysms, or aneurysms that occur inside the skull. A small platinum coil is inserted through an artery in the thigh and threaded through the arteries to the site of the aneurysm. The coil is then released into the aneurysm, where it triggers an immune response from the body.
This immune response causes a blood clot to form inside the aneurysm, strengthening the artery walls and reducing the risk of rupture. Once the aneurysm is stabilized, a neurosurgeon can clamp it off with less risk of bleeding and death to the patient.
Excerpted from Stroke, by the National Institute of Health: Senior Health
