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Ischemic Stroke
Ischemic stroke treatment
Ischemic strokes are caused by a blood clot in an artery in the brain. Treatments available for these types of strokes are time-sensitive, which makes recognition of stroke symptoms and rapid access to medical care critical. In addition, some treatment options are only available at specialized stroke care centers, like the INI.
Medical drug therapy to dissolve clots in the brain
IV t-PA:
Intravenous tissue plasminogen activator (t-PA) is a medication that dissolves blood clots quickly and restores the flow of blood to the brain tissue. It is a thrombolytic agent, more commonly referred to as the "clot buster." It was approved by the FDA in 1996 to treat ischemic-type strokes.
t-PA has been approved to treat brain attacks in the first three hours following the onset of symptoms. If given promptly, 1 in 3 patients who receive t-PA resolve their symptoms or have major improvement in their stroke symptoms.
Bleeding (hemorrhage) is the most common risk that can occur. In 6 out of 100 patients bleeding may occur into the brain or other parts of the body. This bleeding into the brain could be serious enough to cause death; therefore certain conditions may exclude certain individuals from receiving this treatment. Also, stroke sufferers arriving at a hospital outside of the three-hour time window may not be eligible to receive this treatment. Other indications or medical conditions may also preclude t-PA treatment, such as:
- Bleeding in the brain present on the initial brain imaging
- A history or presence of a brain aneurysm or other structural brain abnormalities
- Recent heart attack
- Serious head trauma within the last three months
- Major surgery within previous 14 days
- Bleeding disorders
- Use of blood thinners, such as Coumadin
- Uncontrolled high blood pressure
Interventions to open blocked blood vessels in the brain
Brain cells that do not receive the proper amount of blood flow begin to die within minutes. It takes only 12 minutes for a pea-sized area of brain to die during an ischemic stroke. Removing or dissolving the clot that blocks blood flow must be done quickly in order to save surrounding brain tissue.
Intra-arterial t-PA:
While this treatment has not yet been approved by the FDA for strokes, research results and expert guidelines support the use of this treatment within 6 hours of the onset of stroke symptoms. This treatment involves making a small incision in the groin area and inserting a catheter into the femoral artery. The catheter is advanced through the arteries of the body up to the brain. Dye is injected into the arteries to discover any abnormalities such as a clot that may be obstructing blood flow to the brain. If a clot is found, the t-PA medication can be injected through the catheter right to the clot site to help dissolve the clot.Not all hospitals are capable of providing this type of treatment. The INI Stroke Center has highly trained neuro-interventional radiologists who specialize in providing this treatment option. You or your family member will be asked to give written consent for this procedure.
Mechanical Embolus Removal in Cerebral Ischemia (MERCI) Device:
This treatment has been approved by the FDA for removing clots lodged in arteries in the body. This treatment can be administered up to 8 hours following the onset of stroke symptoms. This treatment involves making a small incision in the groin area and inserting a catheter into the femoral artery. The catheter is advanced through the arteries of the body up to the brain. Dye is injected into the arteries to discover any abnormalities such as a clot that may be obstructing blood flow to the brain. If a clot is found, a small device shaped like a cork screw is implanted into the clot and carefully pulled out of the artery.The INI Stroke Center has highly trained neuro-interventional radiologists who specialize in providing this treatment option. You or your family member will be asked to give written consent for this procedure.
Penumbra Device:
This treatment has been approved by the FDA for removing clots lodged in arteries in the body. Research results and expert guidelines support the use of this treatment in removing clots from brain arteries. Treatment can be administered up to 8 hours following the onset of stroke symptoms. This treatment involves making a small incision in the groin area and inserting a catheter into the femoral artery. The catheter is advanced through the arteries of the body up to the brain. Dye is injected into the arteries to discover any abnormalities such as a clot that may be obstructing blood flow to the brain. If a clot is found, a suction device is carried to the clot by the catheter, and suction is applied to extract the clot.
