Treatment for Stroke
How are strokes treated?
Rapid and accurate diagnosis of the kind of stroke and the exact location of its damage is critical to successful treatment. A good quality CAT Scan of the head being performed and interpreted immediately is the next important step after calling 9-1-1 and arriving at a Certified Stroke Center. Such technical advances as the use of the operating microscope (microsurgery) and the surgical laser have made it possible to treat stroke problems that were thought to be inoperable a few years ago.
Ischemic stroke is treated by removing the obstruction and restoring blood flow to the brain. One treatment for ischemic stroke is the FDA-approved drug, tissue plasminogen activator (tPA), which must be administered within a three-hour window from the onset of symptoms to work best. Unfortunately, only 3 to 5 percent of those who suffer a stroke reach the hospital in time to be considered for this treatment. The earlier tPA is administered the better the reversible outcomes of disability. Time lost is brain lost.
Hemorrhagic stroke often requires surgery to relieve intracranial (within the skull) pressure caused by bleeding. Surgical treatment for hemorrhagic stroke caused by an aneurysm or defective blood vessel can prevent additional strokes. Surgery may be performed to seal off the defective blood vessel and redirect blood flow to other vessels that supply blood to the same region of the brain. One type of hemorrhagic stroke effects younger adults (35 - 50 yrs) that have no risk factors and are in otherwise good health. This sub-arachnoid hemorrhage is best identified by a sudden onset of "the worse headache of your life" - requiring urgent neurosurgery to prevent death.
Types of Treatment
Endovascular treatment involves inserting a long, thin, flexible tube (catheter) into a major artery, usually in the thigh, guiding it to the aneurysm or the defective blood vessel, and inserting tiny platinum coils (called stents) into the blood vessel through the catheter. Stents support the blood vessel to prevent further damage and additional strokes.
The Merci Retriever, approved recently by the FDA, is a corkscrew- shaped device used to help remove blood clots from the arteries of stroke patients. A small incision is made in the patient's groin, into which a small catheter is fed until it reaches the arteries in the neck. At the neck, a small catheter inside the larger catheter is guided through the arteries until it reaches the brain clot.
Another device, the Penumbra®, essentially acts like a tiny vacuum cleaner to suction the clot out of the artery.
Recovery and Rehabilitation
The length of recovery time following a stroke depends on the severity of the stroke. Patients who have had a mild stroke may be able to improve in time on their own without formal rehabilitation therapy. Most stroke patients highly benefit from home, outpatient, or acute in-patient rehabilitation. Within the Centura Health stroke network both St. Anthony Hospital and Porter Adventist Hospital in Denver have in-patient rehabilitation; as well as Penrose Hospital in Colorado Springs, and Centura Health at Home brings care directly to where people live.
For those who have had more severe strokes, rehabilitation programs include:
- Exercise training to improve strength, flexibility, and coordination
- Retraining muscles to reduce spasticity and regain function
- Speech therapy to regain lost speech and comprehension, and improve communication skills
- Swallowing training to learn how to safely eat and drink
- Occupational therapy to practice personal activities of daily living and regain independence
- Outpatient Rehab specializing in stroke
- Home Health specializing in stroke