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Treatments

Stroke Treatments

When stroke happens, seconds count. Every minute the brain lacks blood flow 1.9 million neurons (brain cells) are lost. Fortunately, Doylestown Health Stroke Services offers highly-specialized expertise and advanced stroke treatment options.

Hear from Beverly: Stroke Survivor, IAT Patient

  • Treatment for Hemorrhagic Stroke

    For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels. Sometimes, surgery is needed to save the patient's life or to improve the chances of recovery.

    The type of surgery depends upon the specific cause of brain bleeding. For example, a hemorrhage due to an aneurysm or AVM requires special treatment.

    For other types of bleeding, removal of the hematoma may occasionally be needed, especially when bleeding occurs in the back of the brain.

    One common problem related to brain bleeding is hydrocephalus, which is the build up of fluid within the brain. A procedure called ventriculostomy may be needed to drain the fluid.

  • Treatment for Ischemic Stroke

    Thrombolytics, such as tPA, may be given if the stroke is caused by a blood clot. Such medicine breaks up blood clots and helps restore blood flow to the damaged area.

    People who receive thrombolytics are less likely to have long-term stroke-related problems. However, not everyone can receive this type of medicine. The most important rule is that the person be examined and treated by a specialized stroke team within 3 hours of when the symptoms start. If the stroke is caused by bleeding rather than clotting, thrombolytics can make the damage worse -- so care is needed to diagnose the cause before giving treatment.

    The decision to give the drug is based upon:

    • A brain CT scan to make sure there is no bleeding
    • A physical exam that shows a significant stroke
    • Your medical history

    Thrombolytics are not given to someone who is having a hemorrhagic stroke. They could worsen the stroke by causing increased bleeding.

    A thrombus is a blood clot that forms in a vessel and remains there. An embolism is a clot that travels from the site where it formed to another location in the body. Thrombi or emboli can lodge in a blood vessel and block the flow of blood in that location depriving tissues of normal blood flow and oxygen. This can result in damage, destruction (infarction), or even death of the tissues (necrosis) in that area.

    In other circumstances, blood thinners such as heparin and Coumadin are used to treat strokes due to blood clots. Aspirin may also be used.

    Other medications may be needed to control other symptoms, including high blood pressure. Painkillers may be given to control severe headache.

    In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.

    Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

  • Intra-Arterial Thrombectomy (IAT)

    Revolutionary Stroke Treatment, Close to Home

    Doylestown Health's innovative approach takes stroke care to another level by providing access to advanced stroke treatment not typically offered in a suburban hospital setting. Intra-Arterial Thrombectomy (IAT), commonly referred to as clot retrieval, is clinically shown to be a highly effective treatment for large artery occlusive stroke; improving outcomes and restoring a patient's quality of life.

    What is Intra-Arterial Thrombectomy (IAT)?

    In simplest terms, IAT is the retrieval and removal of a clot blocking the blood flow to an artery. Upon arrival to the emergency room, a stroke patient is typically administered an intravenous dose of the clot-busting medication tissue plasminogen activator (tPA). If the patient does not respond to tPA, they are taken to the catheterization for the IAT procedure.

    During IAT, an interventional cardiologist threads a catheter and highly specialized mechanical stent through the patient's groin artery, directly to the source of the clot that is causing the stroke. The Interventional Cardiologist then uses a retrievable stent to remove the clot, resolving stroke symptoms.

    IAT is a Highly Effective Treatment for Large Vessel Blockages

    Not available at all hospitals, IAT is a breakthrough in the treatment of stroke. Doylestown Health Interventional Cardiologists offer this advanced nonsurgical, catheter-based innovation to diagnose and treat blocked large vessels.

    • IAT improves patient outcomes for large vessel blockages by eliminating the transfer time to another facility.
    • Recent international clinical trials have demonstrated that stent retrievers (IAT), in conjunction with intravenous tPA, give patients with large vessel blockages better outcomes.
    • IAT increases the likelihood of independence after recovery and a quicker return to day-to-day activity a patient experience prior the stroke.
  • Carotid Artery Surgery

    Carotid artery surgery is a procedure to restore proper blood flow to the brain. The build-up of plaque in the inner layer of the wall of an artery may lead to narrowing and irregularity. Where the narrowing is severe, there is a risk that the vessel can block completely if a thrombus forms in the diseased segment.

    You have an artery on each side of your neck called the carotid artery. This artery brings needed blood to your brain and face.

    The blood flow in this artery can become partly or totally blocked by fatty material called plaque. A partial blockage is called carotid artery stenosis (narrowing). Blockage in your carotid artery can reduce the blood supply to your brain. A stroke can occur if your brain does not get enough blood.

    Thrombus

    Sometimes the plaque may close off the artery enough to cause a stroke.

    Other times a blood clot may form in the artery, block the narrow part, and stop blood from reaching the brain. This type of clot is called a thrombus. It stays in one place.

    Embolism

    Other times, the clot can travel and get stuck in a smaller blood vessel in the brain. A clot that travels like this is called an embolism.

    There are two ways to treat a carotid artery that has plaque buildup in it. One is surgery called endarterectomy. The other is a procedure called angioplasty with stent placement.

    During Carotid Endarterectomy

    • You will probably receive general anesthesia. This will make you unconscious and unable to feel pain. Some hospitals may use local anesthesia instead. With local anesthesia, only the part of your body being worked on will be made numb with medicine so that you will not feel pain.
    • You will lie on your back on a padded operating table with your head turned to one side. The side that will face up is the side your blocked carotid artery is on.
    • Your surgeon will make an incision (a cut) on your neck over your carotid artery. Your surgeon will put a catheter (a flexible tube) in place. Blood will flow through the catheter around the blocked area during surgery.
    • Then your surgeon will open your carotid artery. The surgeon will then remove the plaque inside your artery.
    • Your artery will be closed up with stitches after the plaque is removed. Blood will now flow through the artery to your brain.
    • Your heart and brain activity will be monitored closely during your surgery.

    Carotid angioplasty and stenting (CAS) is a less-invasive way to repair the blockage in your carotid artery:

    • Your surgeon will make an incision in your groin after using some numbing medicine. You will also be given medicine to relax you.
    • Your surgeon will insert a catheter (a flexible tube) through the incision into an artery. The doctor will carefully guide the catheter up to your neck to the blockage in your carotid artery.
    • Your surgeon will use live x-ray pictures to see your artery. This kind of x-ray is called fluoroscopy.
    • Next your surgeon will pass a guide wire through the catheter to the blockage. Another catheter with a very small balloon on the end will be pushed over the guide wire and into the blockage. Then the balloon will be blown up. The balloon then presses against the inside wall of your artery. This opens the artery and restores proper blood flow to your brain.
    • A stent (a wire mesh tube) may also be placed in the blocked area. The stent is inserted at the same time as the balloon catheter. It expands when the balloon is blown up. The stent is left in place to help keep the artery open. The surgeon then removes the balloon.

    Why the Procedure Is Performed

    There are several ways your doctor may know you have narrowing or blockage in your carotid artery. Two common ones are:

    • You may have had symptoms of a stroke or a transient ischemic attack (TIA, also called a "mini-stroke"). Some of these symptoms are weakness, blurred vision, confusion, or slurred speech.
    • You may not have any symptoms, but your doctor may find a problem during a physical exam. Your doctor may hear something called a bruit when using a stethoscope to listen to your blood flow. A bruit is an abnormal sound in your artery.

    Your doctor will need to do one or more tests to see how blocked one or both of your carotid arteries are. If you have had a stroke, your doctor will consider whether treating your blocked artery is safe for you. Your doctor will compare your risk of having another stroke if you do not have surgery with the risk of having serious problems from the surgery itself.

    Your Doctor Must Consider:

    • How bad the narrowing in your carotid arteries is
    • What symptoms you have
    • What other medical problems you may have
    • Your age

    Treatment Options Your Doctor Will Discuss With You Are:

    • No treatment, other than checking your carotid artery with tests every year
    • Medicine and diet to lower your cholesterol
    • Tests to check your carotid artery and blood-thinning medicines to lower your risk of stroke. Some of these medicines are aspirin, clopidogrel (Plavix), and warfarin (Coumadin).
    • Surgery to remove the buildup in your carotid artery Most times, patients who have carotid angioplasty and stenting to treat severe narrowing of their carotid artery have this procedure because carotid endarterectomy would not be safe for them.

    Risks

    The risks for any anesthesia are:

    • Allergic reactions to medicines
    • Breathing problems

    The risks for any surgery are:

    • Bleeding
    • Infection

    Risks of carotid surgery are:

    • Blood clots or bleeding in the brain
    • Brain damage
    • Stroke (this is rare)
    • Heart attack
    • Seizures (this is rare)
    • Allergic reaction to dye (only with carotid artery angioplasty)
    • More blockage of the carotid artery over time

    Before the Procedure

    Your doctor will do a thorough physical exam and several medical tests. Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

    During the 2 Weeks Before Your Surgery:

    • You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
    • Ask your doctor which drugs you should still take on the day of your surgery.
    • If you smoke, you need to stop. Ask your doctor or nurse for help quitting.
    • Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery. Do NOT drink anything after midnight the night before your surgery, including water.

    On the Day of Your Surgery

    • Take your drugs your doctor told you to take with a small sip of water.
    • Your doctor or nurse will tell you when to arrive at the hospital.

    After the Procedure

    You may have a drain in your neck that goes into your incision. It will drain fluid that builds up in the area. It will be removed within a day.

    After surgery, your doctor may want you to stay in the hospital overnight so that nurses can watch you for any signs of bleeding, stroke, or poor blood flow to your brain. You may be able to go home the same day if your operation is done early in the day and you are doing well.

    Outlook (Prognosis)

    Carotid artery surgery may help lower your chance of having a stroke. But you will need to make lifestyle changes to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. You may need to change your diet and start an exercise program, if your doctor tells you exercise is safe for you.

  • Medications

    Thrombolytics, such as tPA, may be given if the stroke is caused by a blood clot. Such medicine breaks up blood clots and helps restore blood flow to the damaged area. Persons who receive thrombolytics are less likely to have long-term stroke-related problems. However, not everyone can receive this type of medicine.

    The most important rule is that the person be examined and treated by a specialized stroke team within 3 hours of when the symptoms start. If the stroke is caused by bleeding rather than clotting, thrombolytics can make the damage worse -- so care is needed to diagnose the cause before giving treatment.

    In other circumstances, blood thinners such as heparin and Coumadin are used to treat strokes due to blood clots. Aspirin may also be used.

    Other medications may be needed to control other symptoms, including high blood pressure. Painkillers may be given to control severe headache.

    In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.

    Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

  • Long-Term Stroke Treatment and Rehabilitation

    The goal of long-term treatment is to help the patient recover as much function as possible and prevent future strokes. The recovery time and need for long-term treatment differs from person to person. Depending on the symptoms, rehabilitation may include:

    • Occupational therapy
    • Physical therapy
    • Speech therapy

    Therapies such as repositioning and range-of-motion exercises can help prevent complications related to stroke, such as infection and bed sores. Those who have had a stroke should try to remain as active as physically possible.

    Alternative forms of communication such as pictures, verbal cues, and other techniques may be needed in some cases. Sometimes, urinary catheterization or bladder and bowel control programs may be needed to control incontinence.

    A safe environment must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show indifference or lack of judgment, which increases the need for safety precautions.

    Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.

    In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.

    Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety).

    Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.

    Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke.

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