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In order to change people's perception of stroke as untreatable, there has been a national effort over the past decade or so to call it a "brain attack," acquiring some of the urgency popularly associated with heart attacks. The acute treatment of "brain attacks" has not reached the level of success now achieved with heart attacks. Nevertheless, acute treatment is beginning to show results if done within three hours of onset.

Immediate treatment is needed to:

  • Dissolve a clot causing an ischemic stroke
  • Stop the bleeding during a hemorrhagic stroke

Other stroke care aims to:

  • Reduce the chance of subsequent strokes
  • Improve functioning
  • Overcome disabilities
  • Provide Education and understanding of risk factors, medications, and the importance of compliance with health care recommendations.

Medications

Medications include:

  • Clot-dissolving Drugs – given within three hours of the onset of symptoms. (Note: Only in carefully selected patients.) Tissue plasminogen activator (tPA) is given through a vein after the doctor has confirmed that you are an eligible candidate and there is no evidence of bleeding or other contraindication.
  • Blood-thinning Drugs (Anticoagulants) – An oral medication (warfarin or Coumadin) is sometimes started if long-term treatment with a blood-thinner is anticipated.
  • Antiplatelet Drugs – Aspirin is the most common, but clopidogrel (Plavix), dipyridamole (Persantine), and ticlopidine (Ticlid) are also sometimes used.

Other drugs are used to:

  • Control blood pressure
  • Reduce chance of additional clot formation
  • Treat irregular heart rhythm (such as atrial fibrillation)
  • Treat other causes or risk factors of Stroke

Other interventions during an acute stroke include:

  • Providing adequate oxygen
  • Taking precautions to prevent choking
  • Frequent neurological examinations

Surgery

Surgery may be performed following a stroke or TIA to prevent a recurrence. Surgical techniques include:

  • Carotid Endarterectomy – fatty deposits are removed from a carotid artery (major arteries in the neck that lead to the brain)
  • Carotid Angioplasty and Stenting – in a less invasive procedure than carotid endarterectomy, the carotid artery is widened and a metallic mesh tube and filter is inserted into the artery to help keep it open

Endovascular Therapy

Endovascular therapy allows a specially trained physician to mechanically remove the clot that is causing the stroke symptoms. In January 2018, the American Heart/ American Stroke Association released updated Stroke Care Guidelines that allow for a larger number of patients to be eligible for treatment. Patients meeting select criteria that arrive within 24 hours of their last known well time may be eligible for this form of treatment. Rapid recognition of stroke symptoms allows for the determination of eligibility and transfer to a Comprehensive Stroke Center for treatment. Patients ineligible for the clot busting drug (Alteplase) may be eligible for endovascular therapy.

EMS Stroke Guidelines (Health Professionals Only)
Acute Intracerebral Hemorrhage (ICH) - (Health Professionals Only) 

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