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Major Associated Treatments of Ischemic Stroke (Learn More)Intravenous Recombinant Tissue Plasminogen Activator (IV tPA) Activase was approved by the Food and Drug Administration (FDA) for the treatment of acute ischemic stroke in 1996. The drug is infused intravenously over one hour and must be initiated within 3 hours from the time of onset of stroke symptoms. Well defined protocols and experience are required to rapidly identify and accurately select patients with acute stroke who are candidates for treatment. The administration of tPA for acute ischemic stroke improves the probability of having little or no residual neurologic disability by 30%. The complication rate of symptomatic intracerebral hemorrhage secondary to tPA is 6%. Despite this increased risk of bleeding there is no difference in mortality between patients treated with tPA and those who are not treated.
A patient suffering from acute stroke undergoes intra-arterial stroke therapy. Intra-arterial Stroke therapy/ MERCI Clot Retriever Device — stroke patients who are ineligible for treatment with IV tPA may benefit from interventional catheter based treatments that include diagnostic cerebral angiography, carotid angioplasty/stenting, intracranial angioplasty/stenting, intra-arterial administration of thrombolytic drugs, and a recently FDA approved catheter device (MERCI) for mechanical embolectomy. Patients undergo urgent CT Perfusion or MR Perfusion imaging which are evolving imaging methods that help the stroke team to make decisions about whether a patient may benefit from intra-arterial stroke therapy. These services are provided at specialized tertiary stroke referral centers with experience in acute stroke treatments. Carotid Angioplasty /Stenting (CAS) — certain stroke or TIA patients who are determined to have significant stenosis (narrowing) of the carotid artery may benefit from interventional balloon angioplasty and deployment of specialized carotid stents. CAS has been demonstrated to be effective in stroke patients who are considered higher than usual risk for complications from carotid endarterectomy. There are clinical trials underway to determine the safety and benefit of CAS in stroke patients who are not at high risk of complications from carotid endarterectomy. Carotid Endarterectomy (CEA) — has been proven as an effective preventative surgical treatment for patients with stroke and TIA due to moderate/severe carotid stenosis. Carotid endarterectomy has been demonstrated to be superior to medical treatment in symptomatic patients with carotid stenosis greater than 70%. Selected patients with symptomatic moderate grade carotid stenosis and asymptomatic stenosis may also benefit from CEA. Stroke Units/ Organized Stroke Care — stroke units have been shown to improve outcomes in stroke patients by providing coordinated evidence based treatments resulting in reduced medical complications (i.e. pneumonia, deep venous thrombosis), early mobilization, improved functional outcomes, and reduced mortality. Care is provided by a dedicated multidisciplinary team including:
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