Treatment begins immediately once doctors have confirmed that the patient is having a stroke and determined the type of stroke and other critical information. The approach to treating a stroke caused by blockages such as clots or narrowed arteries (ischemic stroke) is very different than treating a cerebral hemorrhage. Within those two major categories are a number of additional factors that greatly affect how each patient is treated, including other health conditions, medications the patient has taken, and so on.

Ischemic (Blockage) Strokes

Patients are often treated with blood-thinning medications that help open up blocked or narrowed arteries, restoring blood flow to the affected section of the brain. Tissue plasminogen activator (t-PA) is a clot-dissolving medication that has proven effective on certain patients who come to the emergency room within three hours of a stroke's onset. This is one reason doctors urge patients to get medical care at the first signs of a stroke. Even when patients arrive for care within the timeframe required for t-PA, they may not be candidates for the drug and may receive other treatment instead. The Sutter Stroke Center multidisciplinary team caring for the patient will determine whether a blood-thinning agent is the best course of treatment and which thinning agent to give. Other medications may be given as well, depending on the patient's stroke status and any other health issues.

Sutter Stroke Center was one of the national sites that conducted clinical trials for the NeuroFlo™ medical device, approved by the FDA in 2005 as a humanitarian use device for a specific hemorrhagic stroke condition. The center is currently participating in clinical trials for FDA approval to use the NeuroFlo during acute ischemic strokes, as well. The device consists of catheter balloons placed above and below the renal arteries to partially obstruct the aorta, reducing blood flow to the lower extremities and sending more blood to the brain. By restoring blood flow to the affected area, the NeuroFlo helps prevent brain cells cut off from their normal blood supply from dying or malfunctioning. In patients who meet the guidelines for it use, the NeuroFlo has been a valuable tool for doctors to add to their treatment options.

Hemorrhagic (Bleeding) Stroke

Patients experiencing a stroke caused by bleeding in (intracerebral) or around (subarachnoid) the brain are treated very differently than ischemic stroke patients. After determining the patient's condition, doctors work to stop the bleeding through the course of treatment best suited to the patient, which may include medications, microneurosurgery or endovascular (from within the blood vessel) surgery. Sutter Stroke Center physicians include neurologists, neurosurgeons and endovascular surgical neuroradiologists qualified to treat hemorrhagic strokes.

Clipping is one method used to halt blood flow through the blood vessel; endovascular coiling is another. Clipping is a microsurgery technique in which the neurosurgeon places a minute clip at the site of the rupture to stop blood from flowing out of the rupture. Endovascular coiling is performed by an endovascular surgical neuroradiology specialist trained to perform surgery from within the arteries under the guidance of highly sensitive, computer-assisted imaging devices. Prior to treatment, doctors insert a tiny tube and dye into the brain to pinpoint the aneurysm or other cause of the rupture. Once located, they place minute detachable coils made of platinum into the weakened or ruptured vessel to close off its blood supply. When the first coil is in position, it is detached by passing an electrical current that breaks the junction, allowing the coil to remain in the artery. Additional coils are placed until the artery is packed and blood is diverted.

Finding New Treatments

A great deal of research into new stroke treatments is underway, including advances in medications, surgical interventions and medical devices. As an active research center, Sutter Stroke Center sometimes offers patients the opportunity to participate in clinical trials of treatments undergoing final testing for FDA approval. Participation in a clinical trial is completely voluntary and requires informed consent by the patient.