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Treatments and drugs

By Mayo Clinic staff

Emergency treatment for stroke depends on whether you are having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke involving bleeding into the brain.

Ischemic stroke
To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.

Emergency treatment with medications. Therapy with clot-busting drugs must start within 4.5 hours — and the sooner, the better. Quick treatment not only improves your chances of survival, but may also reduce the complications from your stroke. You may be given:

  • Aspirin. Aspirin is the best-proven immediate treatment after an ischemic stroke to reduce the likelihood of having another stroke. In the emergency room, it's likely you'll be given a dose of aspirin. The dose may vary, but if you already take a daily aspirin for its blood-thinning effect, you may want to make a note of that on an emergency medical card so that the doctors will know if you've already had some aspirin.

    Other blood-thinning drugs, such as warfarin (Coumadin), heparin and clopidogrel (Plavix) also may be given, but they aren't used as commonly as aspirin for emergency treatment.

  • Intravenous injection of tissue plasminogen activator (TPA). Some people who are having an ischemic stroke can benefit from an injection of tissue plasminogen activator (TPA), usually given through a vein in the arm. TPA is a potent clot-busting drug that helps some people who have had a stroke recover more fully. However, intravenous TPA can be given only within a 4.5-hour window of the stroke occurring. TPA involves certain risks that your doctors will consider in assessing whether it's the right treatment for you. TPA cannot be given to people who are having a hemorrhagic stroke.

Emergency procedures. Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible.

  • TPA delivered directly to the brain. Doctors may thread a catheter through an artery in your groin up to your brain, and then release TPA directly into the area where the stroke is under way. The time window for this treatment is somewhat longer than for intravenous TPA but still limited.
  • Mechanical clot removal. Doctors may also use a catheter to maneuver a tiny device into your brain to physically grab and remove the clot.

Other procedures. To decrease your risk of having another stroke or TIA, your doctor may recommend a procedure to open up an artery that's moderately to severely narrowed by plaques. Doctors also sometimes recommend these procedures to prevent a stroke. Options may include:

  • Carotid endarterectomy. In this procedure, a surgeon removes plaques blocking the carotid arteries that run up both sides of your neck to your brain. The blocked artery is opened, the plaques are removed and your surgeon closes the artery. The procedure may reduce your risk of ischemic stroke. However, in addition to the usual risks associated with any surgery, a carotid endarterectomy itself can also trigger a stroke or heart attack by releasing a blood clot or fatty debris. Surgeons attempt to reduce this risk by placing filters (distal protection devices) at strategic points in your bloodstream to "catch" any material that may break free during the procedure.
  • Angioplasty and stents. Angioplasty is another technique that can widen the inside of a plaque-coated artery leading to your brain, usually the carotid artery. In this procedure, a balloon-tipped catheter is maneuvered into the obstructed area of your artery. The balloon is inflated, compressing the plaques against your artery walls. A metallic mesh tube (stent) is usually left in the artery to prevent recurrent narrowing. Inserting a stent in a brain artery (intracranial stenting) is similar to stenting the carotid arteries. Using a small incision in the groin, doctors thread a catheter through the arteries and into the brain. Sometimes they use angioplasty to widen the affected area first; in other cases, angioplasty is not used before stent placement.

Hemorrhagic stroke
Emergency treatment of hemorrhagic stroke focuses on controlling bleeding and reducing pressure in your brain. Surgery may also be used to help control future risk.

Emergency measures. If you take warfarin (Coumadin) or antiplatelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract their effects. You may also be given drugs to lower your blood pressure, prevent seizures or reduce your brain's reaction to the bleeding (vasospasm). People having a hemorrhagic stroke can't be given clot-busters such as aspirin and TPA because these drugs may worsen bleeding.

Once the bleeding in your brain stops, treatment usually involves bed rest and supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, surgery may be used in certain cases to remove the blood and relieve pressure on the brain.

Surgical blood vessel repair. Surgery may be used to repair certain blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if you're at high risk of spontaneous aneurysm or arteriovenous malformation (AVM) rupture:

  • Aneurysm clipping. A tiny clamp is placed at the base of the aneurysm, isolating it from the circulation of the artery to which it's attached. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged. The clip will stay in place permanently.
  • Coiling (aneurysm embolization). This procedure offers an alternative to clipping for certain aneurysms. Surgeons use a catheter to maneuver a tiny coil into the aneurysm. The coil provides a scaffolding where a blood clot can form and seal off the aneurysm from connecting arteries.
  • Surgical AVM removal. It's not always possible to remove an AVM if it's too large or if it's located deep within the brain. Surgical removal of a smaller AVM from a more accessible portion of the brain, though, can eliminate the risk of rupture, lowering the overall risk of hemorrhagic stroke.

Stroke recovery and rehabilitation
Following emergency treatment, stroke care focuses on helping you regain your strength, recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. Harm to the right side of your brain may affect movement and sensation on the left side of your body. Damage to brain tissue on the left side may affect movement on the right side; this damage may also cause speech and language disorders. In addition, if you've had a stroke, you may have problems with breathing, swallowing, balancing and hearing. You may also experience loss of vision and loss of bladder or bowel function.

Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous program you can handle based on your age, overall health and your degree of disability from your stroke. The recommendation will also take into account your lifestyle, interests and priorities, and availability of family members or other caregivers.

Your rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.

Every person's stroke recovery is different. Depending on your complications, the team of people who help in your recovery could include these professionals:

  • Neurologist
  • Rehabilitation doctor (physiatrist)
  • Nurse
  • Dietitian
  • Physical therapist
  • Occupational therapist
  • Recreational therapist
  • Speech therapist
  • Social worker
  • Case manager
  • Psychologist or psychiatrist
  • Chaplain
Coping and support Tests and diagnosis
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DS00150 July 1, 2010

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