Joint project with
. This link opens in a new tab.
Your treatment will depend on the type of stroke:
Treatment of ischaemic stroke consists of two different stages:
- Initially, the primary goal is to re-establish blood flow as soon as possible and minimise the extent of brain damage (in colloquial terms, the priority in the acute phase is to «put out the fire»).
- The objective of the second stage is to prevent a recurrent stroke, prevention treatment adapted to the cause of the stroke is provided.
Time is a crucial factor in the first few hours of a stroke (acute phase) as an average of 2 million neurons die every minute. Treatments aimed at recovering blood flow should be used up to 24 hours after the stroke.
- Intravenous thrombolysis. A medicine which dissolves blood clots is injected into a vein.
- Mechanical thrombectomy. A technique used when the blood clot has blocked one of the major arteries carrying blood to the brain. A catheter is introduced into an artery in the groin until it reaches and unblocks the obstructed cerebral artery.
The first effective treatment in the acute phase of stroke is the administration of a thrombolytic drug to break up the thrombus and save part of the brain tissue at risk of dying. This treatment should be administered in the first hours of the stroke and in people who do not have contraindications for receiving it (especially situations that increase the risk of bleeding, since this is the main complication of thrombolytic treatment).
In 2015, five large studies were published worldwide, one of which was carried out in Catalonia (REVASCAT), demonstrating the efficacy of mechanical thrombectomy in patients with severe strokes caused by the occlusion of one of the main arteries in the brain. This treatment consists of inserting a catheter in the inguinal or radial artery, which is advanced to the obstructed cerebral artery to aspirate the thrombus or trap it between the meshes of a stent, before removing it from the circulation.
This procedure must be performed as quickly as possible in hospitals experienced in treating stroke, since the efficacy of the treatment decreases drastically if there is any delay; although there are patients who can benefit up to 24 hours after the stroke.
The benefits of mechanical thrombectomy in more stroke patients are currently being studied; specifically, patients clinically affected relatively mildly, or those with established brain lesions or occlusions of more distal arteries than those usually treated by this technique.
Once the patient has been admitted, and while tests are being carried out to discover the cause, general treatment includes different strategies: prevent another stroke in the following days; control blood pressure and blood glucose levels; maintain adequate blood oxygenation; provide fluids and nutrition; and prevent and treat any stroke-associated complications.
Antiplatelet agents, which limit platelet activity (the blood cells that initiate the coagulation process), or anticoagulants, which interrupt some of the later steps in the coagulation cascade system are prescribed to prevent recurrent strokes.
Blood pressure is managed with either intravenously or orally administered medicines, according to the patient’s blood pressure at any given moment. The ideal blood pressure range varies in function of the extent of the stroke and whether the artery causing the problem remains blocked or has been unobstructed.
High blood sugar levels are associated with a poor recovery from a stroke. For this reason, efforts are made to maintain normal values and avoid low sugar levels, which are also harmful. To control blood sugar, medicines such as insulin sometimes have to be used during hospitalisation, even in patients who have never used it before suffering a stroke.
The most common complications associated with stroke are infections, either respiratory or urinary. Infections must be treated with the appropriate antibiotics as soon as they are diagnosed.
Some cases of haemorrhagic stroke in which bleeding is close to the surface can undergo surgery to remove the blood or treat the bleeding lesion, as in the case vascular malformations. The patient may also require an angiography to repair the damaged blood vessel.For example, if the hemorrhage is secondary to an aneurysm, this can be covered by placing wires (coils) or by placing clips (clips) by surgery. These interventions leave the injured vessel wall out of circulation, which prevents it from bleeding again.
Joint project with
. This link opens in a new tab.
Sorry this content wasn't helpful to you. Send us your comment and we will take it into account to continue improving.
Thanks for your help!
An error has occurred and we were unable to send your opinion, please try again later.
Substantiated information by:
Antonia Fernández
Nurse
Neurology Department
Arturo Renú Jornet
Neurologist
Neurology Department
Xabier Urra Nuin
Neurologist
Neurology Department
Ángel Chamorro Sanchez
Head of the Cerebral Vascular Pathology Unit
Published: 20 February 2018
Updated: 27 December 2022
The donations that can be done through this webpage are exclusively for the benefit of Hospital Clínic of Barcelona through Fundació Clínic per a la Recerca Biomèdica and not for BBVA Foundation, entity that collaborates with the project of PortalClínic.
Subscribe
Receive the latest updates related to this content.
Thank you for subscribing!
If this is the first time you subscribe you will receive a confirmation email, check your inbox
An error occurred and we were unable to send your data, please try again later.
