Stroke happens when the blood supply to the brain is cut off (ischemic stroke) or when a blood vessel in the brain bursts (hemorrhagic stroke), and it is a significant cause of disability and death globally. To reduce brain damage and maximize results, therapy must be administered quickly and effectively.
Our article is all about understanding the best stroke treatment strategies and effective reach-based recovery methods.
The management of a stroke is based on its nature (ischemic or hemorrhagic) and its primary cause. A group of specialists is responsible for the care. In both cases, the individual must be rushed to the hospital for the treatments to be effective.
Those interested in learning how to decrease their stroke risk will find our article on Stroke Prevention to be an invaluable resource.
Depending on the type and severity of your stroke, your treatment, your general health, and how rapidly you recover, the length of time you spend in the hospital will vary.
Treatment for Ischemic Stroke
With advancements in technology, ischemic stroke treatment and transient ischemic attacks (TIAs) may be managed with the administration of medications and medical procedures. Such as
1. Thrombolytic Therapy / Clot-breaking drugs
To treat an ischemic stroke, the blockage must be removed, and cerebral blood flow must be restored.
To achieve this, drugs like tissue plasminogen activator (tPA) are used in thrombolytic therapy to remove the clot and improve blood flow to the brain. It is the gold standard for the treatment of ischemic stroke and the only drug that the FDA approves. This drug cannot be used for the treatment of hemorrhagic strokes due to the increased risk of intracranial hemorrhage.
TPA is a natural enzyme that facilitates thrombus dissolution. By injecting additional tPA into the bloodstream, physicians can accelerate this process. It has the best results when administered quickly following the onset or within 3 hours of the appearance of the symptoms.
Another method by which tPA can be delivered is via direct intra-arterial thrombolysis. It is an advanced procedure in which the drug tPA is injected straight into a blood clot in the brain to break it. It is achieved by inserting a catheter into the groin artery (femoral artery) and then guiding it to the clot. TPA is then sent to the site of the clot to break it up. Extensive stroke care centers typically provide this form of treatment exclusively.
2. Clot Retrieval Devices
With tPA, massive blood clots that obstruct major arteries supplying the brain might not cleave quickly enough. These larger blockages do not respond as frequently to this medication, according to stroke trials, even when administered rapidly.
Modern “thrombectomy devices,” also known as corkscrew-shaped devices, have been specifically engineered to seize and remove the occluding clot, restoring flow to the artery.
To perform this type of treatment, a minor incision is performed in the patient’s pelvic region, through which a thin catheter is inserted until it reaches the vessels located in the neck. Another small catheter is inserted into the larger catheter at the neck and is guided into the brain via the arteries until it reaches the brain lesion. Two types of devices are used to extract the clot from the artery:
- Stent retrievers are wire mesh tubes inserted into the artery, trapping the clot.
- Aspiration catheters, similar to vacuum cleaners, are used to suck out the clot from the artery directly.
Both techniques are found to be effective at physically removing blockages and restoring blood flow to the brain.
3. Antiplatelet and Anticoagulant Medications
These therapies are confined to high-risk patients for the prevention of stroke, particularly those with a history of TIA, or ischemic stroke. They can be broadly classified as anticoagulants or antiplatelet agents.
Anticoagulants (also known as “blood thinners”), including warfarin, and antiplatelet agents (including aspirin, ticlopidine, dipyridamole, or clopidogrel), block the clotting mechanism of the blood and may be significantly beneficial in the prevention of stroke. These medications require close monitoring by a doctor because they prevent the blood from coagulating.
They are also time-sensitive; ideally, they should be performed no later than 24 hours following the onset of symptoms.
4. Stenting and Angioplasty
In patients who may be deemed too high-risk for surgical intervention, carotid angioplasty and stenting (CAS) is a more recent and alternative treatment modality.
In order to help blood flow through a pathway that has plaques blocking it, a neuro-interventional procedure known as carotid stenting involves inserting a thin, metallic mesh tube into the carotid artery. A minor incision of 0.5 cm is performed in the groin to obtain access; however, no incision is created in the neck.
Another method is angioplasty, which is done by implanting the stent. During this, the physician guides a balloon-tipped catheter into the obstructed artery. The artery is then opened by flattening the catheter. This guided stent then stays and acts as a support structure, preventing the occlusion again.
5. Carotid endarterectomy
In a few cases, the plaque is too large to be treated with angioplasty. In such cases, another method is known as carotid endarterectomy. In order to restore normal blood flow, the surgeon will carefully remove the plaque from the plaque artery after making an incision in the neck to reach it during the procedure.
Endarterectomy surgery has been found to have the potential to lower the risk of stroke by 65% in cases where the carotid artery is 70% or more occluded.
Here is a small tabular summary of the treatment options for Ischemic CVAs
|Clot-buster drugs (tPA)
|Drugs used to dissolve blood clots obstruct blood flow to the brain in ischemic strokes.
|Clot Retrieval Devices
|Devices are used to physically remove a clot from a brain artery in certain ischemic stroke cases.
|Medications that prevent new clots from forming and existing clots from growing.
|Procedures to widen narrowed arteries are often used in cases of atherosclerosis.
|Surgical procedure to remove plaque from the carotid artery to prevent stroke.
Treatment for Hemorrhagic Stroke
The symptoms of a hemorrhagic stroke can develop rapidly and unexpectedly, and they are more difficult to treat than ischemic ones. But the key to a complete recovery is receiving treatment as soon as possible.
The extent and location of the homerrhagic brain damage influence the course of therapy. Methods for treating hemorrhagic stroke consist of:
1. Immediate Care
Stabilizing the patient’s condition is the intent of initial treatment. This involves keeping blood pressure up, giving intravenous fluids if needed, and ensuring enough oxygen.
- Blood pressure management: One crucial component in patient outcomes is the ability to restrict hematoma growth, and research shows that aggressive blood pressure lowering can do just that. Systolic blood pressure should not exceed 140 mm Hg, according to guidelines. Reduced blood pressure makes it simpler for clots to form and close up injured blood vessels, reducing bleeding.
- Reversing anticoagulation: Hemorrhagic stroke treatment often discontinues anticoagulants or blood-thinning drugs that may have contributed to hemorrhage. Medical professionals may administer specific treatments to counteract the effects of blood thinners like vitamin K.
- Managing Intracranial Pressure: The management of intracranial pressure (ICP) is important to the treatment of hemorrhagic stroke. To accomplish this, hypertonic saline and mannitol are administered as medications to reduce cerebral edema. Furthermore, mechanical ventilation might be required to assist in regulating ICP and guarantee adequate oxygenation. Also, elevating the head from the body helps.
The objective of treatment for a hemorrhagic stroke is to cause your blood to clot., which is the total opposite of ischemic stroke. As a result, you may prescribed medicine to counteract any blood thinners you are taking. You may also be given medications that can:
- Lower blood pressure
- Reduce the pressure in the head.
- Minimize seizures.
- Minimize blood vessel constriction.
- Pain medications
Sometimes, it might be very important to close up the damaged blood vessel and redirect blood flow to healthy blood veins in the brain. For this purpose, surgical procedures are used. These options include:
- Aneurysm Clipping: This is a surgery where doctors put a tiny clip to the vulnerable region of a cerebral blood vessel known as an aneurysm.
- Blood Transfusion: A blood transfusion might be required in case of substantial blood loss resulting from the operation or hemorrhage. By receiving blood from a donor via an intravenous catheter, the body’s blood supply is replenished.
- Coil Embolization: The purpose of coil embolization is to provide treatment for aneurysms. A catheter is guided to the brain after being inserted into an artery (typically in the buttock). A small coil is subsequently inserted into the aneurysm via the catheter, obstructing blood flow and averting the rupture.
- Draining Excess Fluid: As a result of a stroke, fluid may accumulate in the brain, causing pressure to rise. This fluid can be drained to alleviate pressure and prevent additional brain injury.
- Decompressive Craniectomy: To provide the brain with additional space to expand without introducing further pressure, a portion of the cranium may be temporarily removed in cases of severe brain swelling.
- Surgery to Remove Pooled Blood: In the event that a substantial accumulation of blood (hematoma) develops within the brain, and the patient’s condition continues to deteriorate, the blood may be extracted surgically.
Recent medical care offers sophisticated alternatives for the management of complex conditions associated with hemorrhagic stroke, each of which is customized to the specific condition and requirements of the patient.
Here’s the treatment of hemorrhagic stroke summarized in a table:
|Stabilize blood pressure, administer IV fluids, ensure oxygenation, and reverse blood thinners.
|Control blood pressure, reduce brain swelling (mannitol), prevent seizures (anticonvulsants), and provide pain relief.
|Aneurysm clipping, coil embolization, decompressive craniectomy, draining excess fluid, and surgery for pooled blood.
Recovery and Rehabilitation
Strokes can range from mild impairments like numbness in one limb to complete paralysis or speech loss; however, the severity of these effects varies from person to person. So, the recovery also depends on the area affected. It has been found that 1/3 of the patients suffering from stroke fully recover.
After a stroke, the average duration of hospitalization is between five and seven days. While this is happening, the rehabilitation strategy will be decided upon after the stroke care team assesses its effects.
As a patient recovers and undergoes treatment, specific weaknesses may disappear. Restoring function after a stroke might take a long time—months or even years.
There are a variety of approaches to rehabilitation, including
- Speech therapy: In addition to restoring language and speaking skills, speech therapy can enhance the capacity to regulate the muscles involved in swallowing, breathing, eating, and drinking.
- Physical therapy: Exercise and other physical modalities (e.g., heat, massage) are incorporated into physical therapy. It can assist in restoring or enhancing motor function, including the hands, limbs, feet, and legs. It will also help with muscle atrophy, equilibrium problems, and more.
- Occupational therapy: It can assist in retraining the brain to function normally in daily activities. This treatment is particularly beneficial for enhancing precise hand movements and muscle control.
- Cognitive therapy may prove beneficial for individuals experiencing difficulties with memory. Additionally, it may be beneficial if you encounter challenges with tasks that necessitate concentration or focus that you were previously capable of performing.
- Nursing Care: Assists individuals with disabilities and supports stroke survivors in adjusting to life after the disease, including managing diabetes and high blood pressure.
Rehabilitation experts may aid in developing a treatment plan and in educating family and friends about the patient’s requirements for aid with ADLs.
A stroke indicates a critical and life-threatening medical crisis. In addition to being time-sensitive, strokes can result in irreversible brain injury or fatality if treatment is delayed. Treatment options for stroke are constantly expanding due to advances in imaging technology, technological leaps in brain comprehension, and the development of novel medications.
If your physician suspects that you may be susceptible to stroke, they will collaborate with you to develop an individualized prevention plan that encompasses lifestyle modifications and medical intervention.
Also,the process of recovering from a stroke can be lengthy and irritating. Difficulties are to be expected along the path. With diligence and a readiness to strive for progress, you will be able to maximize your advantages and Prime With Time!