Stroke Treatments

Medications

• Clot-dissolving drugs
  • Given shortly after the start of symptoms—typically given within 3 hours by IV, or intraarterially (IA) within 6 hours
  • Used in carefully selected patients
• Blood-thinning drugs (anticoagulants)
  • Heparin given by vein
  • Oral medication ( warfarin ) given if long-term treatment with blood-thinner is expected
  • Lovenox or other related medications, given subcutaneously (under skin)
  .
• Antiplatelet drugs
  • Aspirin
  • Clopidogrel (Plavix) , dipyridamole (Persantine) , and ticlopidine (Ticlid)

Other drugs are used to:

• Control blood pressure ( labetalol , the first-line drug, or sodium nitroprusside)
• Reduce chance of additional clot formation (aspirin or similar medications)
• Reduce brain swelling
• Correct irregular heart rhythm (eg, atrial fibrillation )

Other interventions during an acute stroke:

• Adequate oxygen
• Precautions to prevent choking
• Frequent neurological examinations

Surgery

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

• Carotid endarterectomy —fatty deposits are removed from a carotid artery (major arteries in the neck that lead to the brain)
• Carotid angioplasty and stenting —less invasive procedure than carotid endarterectomy; the carotid artery is widened and a mesh tube is placed into the artery to keep it open
• Extracranial/intracranial bypass—blood supply is rerouted around a blocked artery using a healthy scalp artery
• Craniotomy—done with a hemorrhagic stroke, to relieve pressure build-up in the brain caused by swelling

A study was done to compare endarterectomy to stenting. Even though endarterectomy is more invasive it led to fewer deaths. It also had fewer repeat strokes than stenting within the first six months. *¹

Rehabilitation

• Physical therapy—to regain as much movement as possible
• Occupational therapy—assist in every day tasks and self care
• Speech therapy—to improve swallowing and speech challenges