How is a stroke treated?

Treatment for Hemorrhagic Stroke and Ischemic Stroke

Stroke is caused when the blood flow to the brain is severely restricted or when a blood vessel ruptures.

There are two types of stroke, hemorrhagic and ischemic stroke, and their causes and treatment are summarised in the table below.

	TYPE OF STROKE
	Ischemic stroke
Occurrence	Most common type of stroke Affects about 85% of stroke patients1
Cause	Caused by a blocked blood vessel to, or within, the brain In many cases this is caused by a build-up of fatty deposits narrowing the arteries and increasing their risk of becoming blocked by blood clots2
Treatment	At present there is only one medicine that is widely recommended to treat ischemic stroke This medicine, a clot-dissolving agent, can only be administered by a doctor and must be given soon after stroke has occurred

	TYPE OF STROKE
	Hemorrhagic stroke
Occurrence	Less common type of stroke Affects about 15% of stroke patients1
Cause	Caused by a bleed from a ruptured blood vessel within the brain In many cases this type of stroke is associated with high blood pressure1,2
Treatment	Doctors may use a variety of medical and surgical techniques to treat this type of stroke1,3 Use of a clot-dissolving agent can make a hemorrhagic stroke event worse1,2,3

Focus on treatment of ischemic stroke

At present there is only one medicine that is widely recommended to treat ischemic stroke. This medicine may or may not be available in your country. The decision on whether it can be administered can only be made by a doctor.

Key facts about this medicine are: 

• This medicine can be very effective in treating ischemic stroke³ 
• There are strict criteria 
  The current medicine can only be administered by a doctor

  • soon after the acute ischemic stroke has occurred,^3,4 and
  • if a brain scan shows that the patient does not have hemorrhagic stroke.

  (The medicine cannot be used in hemorrhagic stroke patients because it may make this type of stroke worse.^1,3,4,)

  for which stroke patients should be treated with this medicine^3,4 

• Not every stroke patient should be treated with this medicine^3,4 
• Often the administration criteria for this medicine are not met
  The strict rules concerning the use of the medicine in ischemic stroke can limit the number of patients that doctors are able to treat with this medicine. The reasons why some patients with ischemic stroke cannot be given the medicine include:

  • many patients arrive at the hospital too late to qualify for treatment with this medicine⁷
  • not all hospitals have facilities for brain scanning and, therefore, cannot check for hemorrhagic stroke and so are unable to offer the possibility of treatment with this medicine

  Circumstances such as these may reduce the opportunity of patients with ischemic stroke being treated with this medicine.

   and, as a result, doctors are only able to administer it to small proportion of patients with ischemic stroke⁶

 

Currently there is only one medicine which is widely recommended for treatment of ischemic stroke. It can only be administered by a doctor and must be given soon after ischemic stroke has occurred. This treatment can be very effective but is not suitable for every stroke patient. Ongoing research is hoping to find new treatments that doctors could use in more stroke patients.

Treatments and procedures in late development for ischemic stroke

Several organisations, including pharmaceutical companies, are working with doctors and nurses to investigate new medicines and procedures for ischemic stroke (eg hypothermia,⁸ surgery to remove blood clots⁹ and neuroprotection¹⁰ ).

Several of these are in the latter stages of development and some may be only available in specialist centres.

Neuroprotective medicines for ischemic stroke

• By protecting brain cells from dying, 
  In ischemic stroke, a blockage of the blood flow, to or within, the brain will deprive some brain cells of their nutrient and oxygen supply. In the area of reduced blood flow there is a central core of cells that are exposed to severe marked reduction in blood supply. These cells die very quickly (the area of dead brain cells is called the infarct). Brain cells surrounding the infarct are serviced by a diminished blood supply. Although they do not die immediately, they are at risk of being killed or harmed by damaging chemicals that are released during stroke. This area of cells, under the threat of destruction by stroke, is called the penumbra. Research suggests that neuroprotective medicines may have the capability to protect the brain cells within the penumbra from dying. ¹¹
  
  neuroprotective stroke medicines may have the potential to reduce the degree of brain injury caused by ischemic stroke.¹¹
• The more brain cells that survive ischemic stroke, the more likely it is that patients will achieve their best possible recovery¹² and best possible quality of life after the stroke.
  
  

References

1. National Stroke Association. Hemorrhagic Stroke Information Sheet.
2. World Health Organization et al. Avoiding Heart Attacks and Strokes. Don’t be a victim. Protect yourself.
3. Medline Plus. Stroke.
4. American Heart Association. Stroke Treatment.
5. Lindley RI, Wardlaw, JM, Sandercock, PA. Alteplase and ischaemic stroke: have new reviews of old data helped? Lancet Neurol 2005; 4: 249-253.
6. Davalos A. Thrombolysis in acute ischemic stroke: successes, failures, and new hopes. Cerebrovasc Dis 2005; 20 (Suppl 2): 135-139.
7. van Wijngaarden JDH, Dirks M, Dippel DWJ, Minkman M, Niessen LW. Towards effective and efficient care pathways: thrombolysis in acute ischaemic stroke. QJM 2006; 99: 267-272.
8. The Internet Stroke Center. Stroke Interventions in Clinical Trials. Hypothermia.
9. The Internet Stroke Center. Stroke Interventions in Clinical Trials. Trials with MERCI retriever.
10. The Internet Stroke Center. Stroke Interventions in Clinical Trials. Neuroprotective agents.
11. Lyden P, Whalgren NG. Mechanisms of Action of Neuroprotectants in Stroke. J Stroke Cerebrovasc Dis 2000; 9 (Suppl 2): 9-14.
12. Patsy Westcott. The effects of stroke.