Treatment for Stroke

What is the Standard Treatment for Stroke?

This information is not intended as a substitute for professional medical care.  Always follow your healthcare professionals instructions.

The most promising treatment of ischemic stroke is the FDA-approved, clot-busing drug t-PA (tissue plasminogen activator) which must be administered within a four and half hours from the onset of symptoms.  The sooner it is administered, the more effective it is.  It has been used to treat well over 100,000 ischemic stroke patients.

Administering t-PA or other clot-dissolving agents is done through an intravenous (IV) line in the arm by hospital personnel over 60 minutes.  If given promptly, t-PA can significantly reduce the effects of stroke and reduce permanent disability.

Generally, only 3 to 5 percent of those who suffer a stroke reach the hospital in time to be considered for t-PA treatment.  If t-PA is used there is a 32% chance that the patient will be normal or improved after the administration.  After 1 year, the recovery rate with minimal or no deficits is 41% and the overall rate of death is recued by 4% when compared to patients who did not receive t-PA.  The medication is not risk free and comes with a 6.4% that there will be early worsening from brain bleeding.  Of those who suffer adverse effects from t-PA, 2% will experience worsened symptoms and 1% will be severely disabled or die.

The decision to treat acute ischemic stroke with tPA may change a patients life.  It is important you to discuss the benefits and risks with your doctor to make the best choice. Not all patients with ischemic stroke are eligible for tPA therapy.

Barriers to Stroke Treatment

• t-PA can potentially benefit most stroke victims. Stroke patients who receive t-PA are at least 55% more likely to leave the hospital with little or no disability after three months.
• Only hospitals with certified stroke centers are equipped to immediately treat stroke victims well within the 3- 4.5 hour window.
• Less than 3% of stroke patients receive t-PA nation wide. Some reasons include:
  • Typically patients arrive 12 – 24 hours after the first stroke symptom.
  • Family and friends as well as bystanders who attempt to help a stroke victim may not recognize the warning signs or the need for rapid transportation
  • Stroke symptoms may be hard to identify and are often mis-diagnosed by emergency medical personnel.
  • Patients often wait for their primary care physicians in the emergency room instead of seeking immediate treatment by neurologists at certified stroke centers.

 What are my other treatment options?

If IV t-PA treatment cannot be initiated within 4 ½ hours or if IV t-PA treatment alone is not enough to dissolve the clot, interventional radiologists that specialize in neurological procedures may be able to provide future treatment.

The interventional radiologist may be able to treat your blocked blood vessel or bulge in the vessel (aneurysm). Treatment depends on the site of the blocked artery and the scans done to tell if you would benefit from invasive treatment.  Not all patients who have a stroke will benefit, but if your doctor believes you could you will be taken for an angiogram (a special X-ray exam of the arteries and veins).

For ischemic stroke, a thrombectomy, or removal of a clot, may be done by inserting specialized devices in through a tiny catheter and guiding them under x-ray to the brain.  Thrombolysis, the dissolving of a clot by administering special medication, can also be administered through the tin microcatheter.  Techniques called Angioplasty (balloon catheter) and Stenting (a metal tube placed in the blocked area) can be done for stenosis (narrowing of a blood vessel) in certain conditions.  These are just some of the treatments that can be offered if appropriate for you.

If you stroke is caused by a ruptured aneurysm your doctor can insert tiny coils to take up the space of the aneurysm and prevent it from bleeding further.  A stent may be used to help keep the coils in place.  With angiographic imaging, your doctor will decide what is right for you.

Learn About New Options for Stroke Survivors: SanBio

A new clinical trial is testing SB623, an adult stem cell therapy that has been successfully evaluated in preclinical models of stroke. In this clinical study, safety as well as efficacy parameters will be evaluated, such as improvements in motor function and cognitive status. SanBio has completed the first cohort of their clinical trial with six patients successfully receiving the stem cell therapy. SanBio continues to recruit patients and hopes to accelerate the scheduling of patients during the second and third cohorts.  For more information on this clinical trial, please visit strokeclinicaltrial.org.