We have all probably known someone in our lives who has had a stroke. When thinking about it, it may evoke feelings of deep sadness, especially if that person lost mobility or their speech. Watching someone lose vital functioning is heartbreaking. For these reasons alone, we feel it is imperative that we dedicate some time on how to prevent strokes, to identify stroke symptoms FAST and then seek quick and appropriate treatment. As we wrap up our series on strokes, we will be discussing treatment options for TIAs, as well as, ischemic and hemorrhagic strokes. We will also talk about how to know the right place to go for treatment, in the event you or your loved one has signs of a TIA or stroke.

TIA Treatments

The doctor will first need to quickly figure out the cause of your TIA and then decide the appropriate course of action. Some of the tests may include: a computerized tomography (CT) or with angiography (CTA), a magnetic resonance imaging (MRI) or with angiography (MRA) and/or an echocardiogram. The goal is to prevent a stroke from occurring. The following are the treatment options:

Anti-Platelet Medication – If it is determined that the TIA is due to a narrowing of a major artery in the brain, you or your loved one may be given a combination of aspirin and clopidogrel.

Anticoagulant Medication – If the TIA is due to an abnormal heartbeat (atrial fibrillation), the doctor may prescribe an anticoagulant medication, such as warfarin.

Carotid Angioplasty – If there is a significant amount of plaque “fatty deposits” found in the artery that supplies the blood to the brain, then surgery may be recommended. The angioplasty surgery involves a balloon-like instrument that opens up the blocked artery, and then places a stent in there to keep the artery opened.

Carotid Endarterectomy – Another way of clearing the plaque from the artery is by making an incision to remove the plaque from the artery.

Some of these treatment options seem scary, but remember that the alternative is much worse. These are life-saving treatments that can prevent a disabling stroke from occurring.

Ischemic Stroke Treatments

One of the first things a medical professional will ask is “When was the last time you or your loved one was seen asymptomatic?” It is important to track when those changes occurred, as that will dictate which treatment option would likely be the most successful. Sometimes people will have what is called a “wake up stroke.” It means that when a person wakes up, they are experiencing stroke symptoms that were not present when they went to bed. Up to 20% of stroke patients experience a wake up stroke, which is a type of an ischemic stroke. [1] This situation can be rather challenging, as it is critical to find out when the stroke occurred. The doctor will also need to determine where the blockage has occurred through various tests, such as an angiogram, CT or MRI scan. The doctor will then need to work fast to restore blood flow to the brain. The following are the couple of treatment options available, if deemed a candidate:

Intravenous injection of tissue plasminogen activator (tPA) – It is a clot-busting medication that restores the blood flow to the brain. It needs to be administered within 4.5 hours if injected into a vein, but ideally within 3 hours of the onset of stroke symptoms. It is best to be given quickly as it can greatly reduce the chances of complications or long-term effects. It does come with some risks, so the doctor will have to decide if tPA is appropriate for you or your loved one.

Emergency Endovascular Procedures:

Tissue plasminogen activator (tPA) delivered directly to the brain – It is a treatment that is called intra-arterial thrombolysis. This procedure delivers the tPA directly to the area of the clot to try and prevent further brain damage. For this to be effective, it needs to be started within a few hours of a stroke.

Removal of clot with stent retriever – A mechanical device goes in and removes the clot to those patients who are eligible. The eligibility depends on a variety of factors, but the timing is a large factor. This procedure should be done within six hours of acute stroke symptoms. Under certain conditions, it could also be used within 24 hours of the onset of stroke symptoms. It is generally used when the clot is fairly large and cannot be broken up and dissolved by tPA.

Hemorrhagic Stroke Treatments

For hemorrhagic strokes, a CT scan is generally the fastest and the best option to find out where the bleeding is inside the brain. The doctor may order other tests, such as blood work, MRA, or lumbar puncture to diagnose what is happening. In terms of treatment, the primary focus is to control the bleeding and reduce the pressure in the brain. Once it is controlled, surgery may be a consideration to ensure hemorrhaging does not occur again.[2]

Where to Go in the Event of a Stroke

If you or your loved one is having symptoms of a stroke, you just assume you go to any area hospital, right? Wrong. Not every hospital is equipped to handle strokes and perform all the various treatments that were mentioned earlier. There are certain hospitals that are certified as stroke centers. Within those that are certified, are varying levels of expertise and resources. There are three main types of stroke certifications:

  • Acute Stroke Ready Hospital
  • Primary Stroke Center
  • Advanced Comprehensive Stroke Center

Advanced Comprehensive Stroke Centers have the greatest abilities and resources in terms of treating a stroke.

The hospitals get certified through the Joint Commission, which is an independent organization that developed a stroke certification program in collaboration with the American Heart Association and the American Stroke Association. Although some states have certification through their State Department of Health. The Joint Commission put together a comparison chart between the different certified stroke centers. The Joint Commission also has a complete, exhaustive list of all the hospitals who are certified and what level they are considered. However, it is best to talk to your loved one’s primary care doctor or a neurologist, if they have one. Ask them where the best place in the area is to go if displaying symptoms of a TIA or a stroke.

Rehabilitation

Depending on the level of severity of complications due to a stroke, rehabilitation may be necessary to assist with any skills that may have been lost after a stroke. Research has shown that people who participate in a stroke rehabilitation program do much better than those who do not take part in a program.[3] Click here to search for an accredited stroke rehabilitation program.

Any type of stroke or TIA requires immediate attention, as it can be the difference between life or death. It is prudent to be proactive and have a plan in place. As the old adage says, “An ounce of prevention, is worth a pound of cure.” The good news is that there have been vast improvements in acute stroke treatments over the years. It is comforting to know that when someone now displays symptoms of a TIA or a stroke, it does not necessarily mean a complete life altering situation. If it is addressed quickly, a life can be saved and have minimum to no disability.

Next week, we are going to switch gears. After getting through all these weeks of difficult material, we will be talking about gardening. It is May after all, which means planting time!

[1] https://www.medicalnewstoday.com/articles/317111.php

[2] https://www.verywellhealth.com/joint-commission-certified-stroke-centers-by-state-3146380

[3] https://www.mayoclinic.org/diseases-conditions/stroke/in-depth/stroke-rehabilitation/art-20045172

Other References:

https://my.clevelandclinic.org/health/diseases/14173-transient-ischemic-attack-tia-or-mini-stroke/management-and-treatment

https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119

https://www.ohsu.edu/xd/health/services/brain/getting-treatment/diagnosis/stroke/treatment-options/surgery-neuro-interventions/intra-arterial-thrombolysis.cfm