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Acute Treatment of Stroke

Intravenous Thrombolysis:

In 1997 the FDA approved the infusion of a “clot-busting” medication called tissue plasminogen activator (tPA) into the veins for patients who present with stroke symptoms within 3 hours of onset to restore bloodflow into the affected part of the brain. Studies show tPA increases the stroke victims chances of survival and recovery. Newer research (ECASS-III) suggests this treatment may even be safe and effective up to 4.5 hours after onset. However, the quicker you receive treatment, the less damage will occur.

TIME IS BRAIN

tPA is not safe for everyone. A CT of the brain is necessary to rule out a hemorrhagic stroke which would be made worse by this treatment. Also, patients with recent surgery, patients on strong blood thinners or with recent events of bleeding cannot receive this treatment.

Unfortunately, increasing stroke severity decreases the chance of this treatment to restore blood flow.

Using Telemedicine this treatment is available in all hospitals participating in the StrokeCareNow Network (SCNN).

Intra-arterial Thrombolysis and Embolectomy.

Telly
The MERCI retriever

Patients who cannot receive intravenous tPA or whose occluded brain vessels failed to open with this treatment may be candidates for catheter-based treatment or intra-arterial thrombolysis.

In intra-arterial thrombolysis the clot busting medication is directly delivered to the blood clot through a small catheter or tube. New treatment options include mechanical embolectomy, the removal of the blood clot with a device.

Telly
The Penumbra system

The MERCI retriever is a small corkscrew that is placed behind the blood clot. A balloon is inflated in the neck shutting off blood flow to the brain as the clot is pulled and sucked out of the brain.

The Penumbra system is a set of special very flexible catheters and “cleaning wires” that are used to directly suck out the blood clot.

This requires a special angiography machine that allows two simultaneous viewing angles and specially trained physicians called NeuroInterventionalists. These treatments are only available in “comprehensive stroke centers” such as Parkview Hospital or Lutheran Hospital in Fort Wayne, Indiana.