Treatments for Stroke
Miami Valley Hospital's Advanced Primary Stroke Center is staffed by a multidisciplinary team of specialists who provide various treatments for ischemic and hemorrhagic strokes. Treatment for stoke varies based on the type of stroke (ischemic or hemorrhagic) that occurs.
Treatments for Ischemic Stroke
Strokes caused by blood clots — ischemic strokes — are the most common. An artery to the brain becomes blocked and stops the flow of blood to the brain. Immediate treatment focuses on restoring blood flow.
Tissue Plasminogen Activator (tPA)
The clot-busting drug tissue plasminogen activator (tPA) can be infused intravenously (through a tube in a vein) at Miami Valley Hospital to prevent stroke damage. tPA can dissolve the clot and restore the flow of blood and oxygen to the brain. The drug must be given as soon as possible after stroke symptoms begin, ideally within three to four-and-a- half hours. That’s why it is essential to get immediate emergency medical help if you notice the warning signs of a stroke. tPA occurs naturally in the body as an enzyme made by cells in blood vessel walls. Miami Valley Hospital stroke specialists use a genetically engineered version, which was first employed in the treatment of blood clots in the heart.
Intra-Arterial Catheter Reperfusion
While tPA is the most common form of treatment for ischemic stroke, the stroke team at Miami Valley Hospital also uses the Intra-Arterial Catheter. This option is for some patients who arrive at the hospital more than four and half hours after the onset of stroke symptoms. Intra-Arterial Catheter Reperfusion has a coiled tip that grasps a blood clot and allows it to be removed.
Intra-Arterial Catheter Reperfusion can be used up to twelve hours after the onset of stroke symptoms. This is a significant breakthrough because valuable time is often lost before a patient recognizes that they are having a stroke.
Solitaire Revascularization Device and 5Max™ ACE Clot Removal Device
Miami Valley’s stroke specialists were the first in Southwestern Ohio to provide treatment with the Solitaire revascularization device. The Solitaire procedure can be given as long as eight hours after a stroke began. Solitaire improves long-term ability to function normally after a stroke — including speech and mobility.
Solitaire is a minimally invasive technology (done through a small incision) similar to a stent procedure for heart blockage. The surgeon threads a thin catheter through an artery in the groin to the area of blockage in the brain artery. Then the surgeon puts a miniature stent (a wire mesh tube that expands inside your artery) through the catheter. The stent opens in the blocked artery, and blood flow is restored. The blood clot causing the blockage sticks to the stent after several minutes, and the stent and clot are removed through the catheter.
Miami Valley Hospital is now also using the 5Max™ ACE clot removal device to remove blood clots causing an ischemic stroke. The device is threaded through an artery in the groin to the area of blockage in the brain artery. The 5Max™ ACE allows the neurointerventionalist to suction the clot out of the artery and re-establish blood flow more quickly and with less tissue trauma.
Treatments for Hemorrhagic Stroke
Hemorrhagic strokes occur when an artery in the brain leaks blood or ruptures. The blood accumulates, increasing pressure inside the skull and compressing the brain tissue. Immediate treatment focuses on controlling bleeding and pressure inside the skull. Conditions that can lead to bleeding in the brain — and a stroke — include high blood pressure, trauma, brain aneurysms, brain arteriovenous malformation (AVM) and certain tumors.
The treatment of bleeding in the brain requires specialized training and technology available at Miami Valley Hospital. We offer several unique procedures to control bleeding within the brain, including coil embolization, aneurysm clipping and a pipeline embolization device, as techniques to treat hemorrhagic stroke.
Repair of a brain aneurysm using coil embolization is a minimally invasive procedure performed by a neurointerventionalist who repairs the aneurysm without opening the skull. During the procedure, the specialist manipulates a catheter through the arteries, starting in the leg, to ultimately insert tiny coils to treat the aneurysm. The coils fill the aneurysm and prevent blood from entering, eventually causing a clot to form to seal off the aneurysm.
Aneurysm clipping is reserved for brain aneurysms that are not easily treated with coil embolization. This procedure involves opening the skull and inserting a tiny clamp at the base of the aneurysm, which stops blood flow to the aneurysm.
For specific brain aneurysms, our neurointerventional team can insert a pipeline embolization device, a mesh tube that diverts blood flow away from the aneurysm to promote clotting of the aneurysm over time.
We also offer additional treatments for delayed effects of a brain hemorrhage for both relief of symptoms and prevention of additional damage to brain cells, including:
- Surgery – both to relieve pressure inside the head and to remove excess blood in areas where it may cause further damage – using procedures such as EVD (external ventricular drain), hematoma evacuation and hemicraniectomy
- Medications such as calcium channel blockers to prevent complications from lack of blood flow to the brain after a rupture
- Injections (in a vein) of a medication called a vasopressor to prevent a stroke
- Injections through a catheter (tube) to deliver drugs called vasodilators to decrease pressure on the brain
- Anti-seizure medications to treat seizures related to a stroke
- Surgeries to open blocked veins that drain blood from the brain