Stroke

Treatment

Anyone can have a stroke; however, most strokes are preventable by making healthy lifestyle changes. Learn what you can do to reduce your risk of having a stroke by discussing it with your doctor, but the list below is a good place to start.

1. Adopt a heart-healthy diet – Strive to eat a balanced diet with plenty of fruits, vegetables, grains, and a moderate amount of protein (meat, fish, eggs, milk, nuts, tofu, and some beans). Eating foods with lots of fiber, such as whole-grain breads and cereals, raw fruits and vegetables, and dried beans, and reducing salt and fat has been found to reduce cholesterol and lower blood pressure, thus helping lower your risk of stroke.
2. Stop smoking – Smoking doubles your risk of having a stroke. You can dramatically lower your risk of stroke by quitting today. If you choose not to quit smoking, at least try to cut back.
3. Keep your blood pressure under control – If you have high blood pressure, it can damage the blood vessels and increase your risk of stroke. If you have concerns, discuss them with your doctor, as you may need medication to help lower and maintain your blood pressure.
4. Exercise regularly – A brisk walk for just 30 minutes each day is good for your health and may reduce the likelihood of a stroke. If walking isn’t your favorite activity, choose another activity that you enjoy. The important thing is to make time each day for exercise.
5. Find out if you have atrial fibrillation (Afib) – AFib is an irregular heartbeat that contributes to blood pooling (and clumping or clotting) in the upper chamber of your heart. Clots pushed out of the heart by its beating can lodge in vessels and block blood flow to the brain, causing a stroke. If you have AFib, your care team may prescribe medications that thin the blood and prevent it from clotting as easily, or your doctor may recommend a procedure that prevents blood clots from forming in your heart and traveling to your brain, where they could cause a stroke.
6. Limit alcohol intake – Too much alcohol can significantly increase your stroke risk. If you must drink alcohol, limit your intake to no more than one drink (equal to 1.5 ounces of liquor, 5 ounces of wine, or 12 ounces of beer) per day for women* and two drinks per day for men*.¹
7. Lower your cholesterol – Cholesterol is a soft, waxy fat in the bloodstream and the body’s cells. A total cholesterol level of more than 200, a high “LDL” (“bad” cholesterol) level, or a low HDL (“good” cholesterol) level may indicate an increased risk for stroke. If your cholesterol is high, your doctor may recommend making lifestyle changes, including eating a heart-healthy diet and getting regular physical activity to bring it down. You may also prescribe medications to lower your cholesterol and reduce your risk for stroke.
8. Control your diabetes – By controlling your diabetes, you may reduce your risk of stroke. Successfully managing diabetes requires following your doctor’s advice on eating habits, exercise, and diabetes medications.
9. Find out if you have blood or blood circulation problems – Ask your doctor if you have blood or blood circulation problems that could increase your risk for stroke. If you have sickle cell disease, severe anemia in which your red cell count is lower than normal, or other blood conditions, talk to your doctor about medication and other ways of treating them to reduce your risk of stroke.
10. Follow up with your doctor on testing and treatment – Your doctor can check blood flow through your heart and arteries using a variety of tests. Depending on the results, your doctor may prescribe medications or recommend medical procedures to improve blood flow and reduce your risk of stroke.

Once your doctor determines that you had a stroke, the next step is to quickly determine if the stroke was ischemic or hemorrhagic, as immediate treatment will be different depending on the type of stroke. In addition, your unique circumstances, such as your age and other risk factors, play a role in your treatment and ongoing care.

Ischemic stroke

An ischemic stroke happens when blood flow to the brain is restricted or blocked. Once the cause of the ischemic stroke is determined, the doctor may give you a dose of aspirin or other drugs to thin your blood. But don’t take aspirin before coming to the emergency room because aspirin could increase bleeding if you have a hemorrhagic stroke.

• Tissue plasminogen activator (r-tPA) – A patient with an ischemic stroke may be given r-tPA, a clot-dissolving medicine that helps open up blocked arteries. Patients who receive t-PA within the first three hours after their first stroke symptoms seem to have a better chance of recovering and fewer complications. Unfortunately, most people with ischemic strokes don’t receive this treatment because they don’t make it to the hospital in time or are not diagnosed quickly enough after they arrive.
• Surgery – A carotid endarterectomy is a surgical procedure that removes blockages from arteries in the neck that supply blood to the brain.
• Interventional procedures – Physicians also use balloon angioplasty and stents to open the artery blocked or narrowed by fatty deposits or plaque buildup. Carotid artery stenting works by reopening a blockage in the carotid arteries through a thin tube (catheter) and then propping the affected artery open with a mesh tube (stent). This procedure helps filter the blood flowing to the brain, preventing bits of plaque or blood clots from passing to the brain and causing a stroke.

Hemorrhagic stroke

A hemorrhagic stroke occurs when a blood vessel in the brain bursts or weakens, allowing blood to leak into the brain. With this type of stroke, it's very important to control the bleeding, so don’t take aspirin or any other blood-thinning medication before going to the emergency room. Like ischemic strokes, hemorrhagic strokes can be treated with interventional procedures or surgery. Depending on the stroke’s cause, your doctor may choose one of the following procedures:

• Aneurysm clipping – If your stroke results from an aneurysm in the brain, your doctor may place a clamp at the base of the aneurysm. This separates the aneurysm from the artery to which it’s attached to prevent it from bursting or rebleeding if it has already leaked blood.
• Coiling (aneurysm embolization) – A catheter delivers a tiny coil to fill an aneurysm in this procedure. This seals the aneurysm from connecting arteries, reducing the risk of rupture.
• Surgical removal of malformed arteries in the brain – Surgical removal of malformed vessels in the brain, also known as brain arteriovenous malformation (AVM), may be possible if they’re not too large and are accessible. Removal eliminates the possibility of their rupture and lowers the risks of a hemorrhagic stroke.

Treatment of patent foramen ovale (PFO)

A PFO, or a hole in the heart, is a type of heart defect that may increase the risk of a stroke. We’re all born with a trapdoor-like opening between the heart's upper left and right chambers (atria). For most of us, the hole closes soon after birth, but for others, it never closes on its own. The PFO can be closed during open-heart surgery or with less invasive interventional procedures.

Ongoing care

During the first few hours and days after a stroke, you’re at a greater risk of having another stroke. Stroke patients are also very susceptible to serious complications, including seizures, brain swelling, and infections such as pneumonia. It will take time to assess how much damage the stroke did. Although the brain will begin to adapt and change its functioning to accommodate the loss of some parts, it can take a long time.

Once you’ve had a stroke, your primary care doctor may refer you to a cardiologist since they have specialized training in treating blockages in the arteries, preparing them to treat most strokes. Even if referred to a cardiologist, your primary care doctor will continue to play a role in your care. Your doctor should continue to be a key care team member, working with you to control risk factors and coordinating your care with your cardiologist and various support teams.

On the horizon

Stroke care has come a long way. Doctors have learned a lot from treating heart disease with catheter-based treatments such as angioplasty and stenting, and they have transferred that knowledge to treating strokes. Neuro-rescue stroke treatments are revolutionizing stroke care. Emergency medical responders, hospitals, and clinics are establishing and improving systems to help patients get the treatment they need as soon as possible.

You can also learn about new developments in stroke care by talking with your doctor about participating in a clinical trial.

Recovering from a stroke

Recovering from a stroke can be challenging and frustrating. Work with your doctor and other healthcare professionals to prevent complications and another stroke. The complications or disabilities you or your loved one face depend on the location and extent of the damage to the brain from the stroke. You may or may not have any of these difficulties. It depends on how your stroke affected you.

The following list of stroke complications will help you identify the problems to discuss with your doctor and others involved in your rehabilitation to make life easier and feel better after a stroke.

You must work closely with your doctor to monitor your health after a stroke to address these complications and prevent other problems, including another stroke. Treatment and care for a stroke don’t end when you leave the hospital. You’ll need to continue to see your doctor to receive the appropriate medications and coordinate your other treatment, such as physical therapy and other forms of stroke rehabilitation. With the help of stroke care professionals and your family and friend caregivers, you can begin to recover as much of your former ability as possible and find ways to adapt or work around the difficulties stroke has brought to your life.

Returning to work

According to the Centers for Disease Control and Prevention (CDC), about 38% of people in the U.S. who were hospitalized for a stroke in 2014 were under 65. So, returning to work is a big concern for this group during rehabilitation. A vocational therapist can work with you and your caregivers to advise you of your right to reasonable accommodations in the workplace and coping with your return to work.

A note about depression

If you feel terribly sad or bad about yourself after your stroke, have trouble sleeping, see little point in living, have lost your appetite, lost interest in your usual activities, or experience any other emotions that prevent you from feeling better and moving forward with your recovery, talk to your friends, family, and doctor about it. Get help. Depression isn’t a sign of personal weakness; it’s a medical illness with treatment options that can make you feel better and help you recover from your stroke.
 

*The term “women” in the context of “women’s cardiovascular health” applies to individuals assigned female at birth (AFAB) who have a female biological reproductive system, which includes a vagina, uterus, ovaries, Fallopian tubes, accessory glands, and external genital organs.

*The term “men” in the context of “cardiovascular health” applies to individuals assigned male at birth (AMAB) who have a male biological reproductive system, which includes a penis, scrotum, testes, epididymis, vas deferens, prostate, and seminal vesicles.

References 

1. Dietary Guidelines for Americans, 2020-2025