Stroke Treatment

In stroke, prevention is the key to vitality of a patient. However, if signs and symptoms of stroke begin to become evident, there are several different treatment options. In ischemic stroke, which is what I've predominantly focused on in this blog, there are two main treatments: tPA treatment and mechanical thrombectomy.

tPA Treatment
A treatment of tPA, or tissue plasminogen activator, may be used to treat ischemic stroke, and is the only FDA approved treatment available. It is typically given through an IV method, and works to dissolve the blood clot that is present in order to restore or improve blood flow to the brain. The goal of this treatment is to minimize the damage that may be caused from stroke occurrence. It's important that it is administered within three hours of stroke incidence in order to increase the possibility of stroke recovery. Many patients don't go to the hospital soon enough to utilize tPA treatment, which is why early detection of symptoms is crucial.
     
     Side effects of tPA treatment: A tPA infusion can damage the basal lamina of blood vessels. This results in edema, disruption of the blood brain barrier, or hemorrhaging. This means that a patient previously taking any anti-coagulant medication or a patient at risk for hemorrhage doesn't qualify for tPA treatment. The National Institute of Neurological Disorders and Stroke found that 1 in 18 patients having tPA therapy experience brain bleeding, leading to a 45% mortality rate in these cases. These complications are more common in adults over 70 years of age, and those with a glucose level greater than 300 mg/dl. Using more than the recommended dose of tPA also has very adverse effects related to internal bleeding.

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Endovascular Procedures
Another treatment method of stroke is known as mechanical thrombectomy. In this procedure, doctors attempt to remove the blood clot using a stent retriever. This occurs by threading a catheter in a groin artery back up toward the blocked artery in the brain. The stent then opens and "grabs" the clot, which doctors then remove along with the stent removal. This procedure can only be done after tPA treatment, and a patient must meet certain criteria before a mechanical thrombectomy occurs.
     Side effects: Mechanical thrombectomy can cause intercranial blood vessel wall trauma, thus making other complications more likely. With any medical procedures come risk for infection, arterial damage (due to catheterization), and anesthetic risks, especially when considering that many stroke patients are in the elderly population.

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Stroke Treatments
Side effects of tPA Infusion
More tPA effects