Every minute the brain is deprived of blood flow, more brain cells die. The earlier the blood flow is restored, the less likely a stroke patient will have permanent damage. Neuro Critical Care is essential to control intracranial pressure as well as blood pressure, breathing, and heart function.
Not only must physicians diagnose if someone has just had a stroke, they must also determine the type of stroke as treatment options vary, based on whether the stroke is hemorrhagic or ischemic, as well as on the stroke’s severity.
Physicians will order a variety of diagnostic tests to determine the location and extent of brain injury, as well as evaluate the condition of the arteries in your neck and brain that supply blood to your brain.
- Ischemic stroke: The most effective medicine for the treatment of ischemic stroke is the FDA-approved drug, t-PA (tissue plasminogen activator). Administered intravenously, it works with your body's enzymes to dissolve blood clots. This highly-effective treatment must be given within 4.5 hours of the onset of stroke, so it imperative to seek medical care immediately. For certain ischemic strokes where t-PA cannot be administered or is ineffective, endovascular clot removal may be an option.
- Hemorrhagic stroke: The best and safest way to remove blood from the brain after a hemorrhage and minimize damage to the brain may include minimally invasive surgical removal of the clot (through small catheters or tubes), clot busting medication to dissolve the clot, and medications to minimize swelling caused by the clot. For hemorrhages caused by aneurysms and arteriovenous malformations, a skilled neuro-interventionist or neurosurgeon can repair or block the vessels to prevent further bleeding. Many of these procedures can be performed through a minimally invasive technique.
Advanced Endovascular Treatment
Beyond providing the highest level of emergency stroke intervention, neuro-interventionists are helping to shape new standards of care for cerebrovascular patients through endovascular approaches. These consist of minimally invasive surgical treatments for cerebrovascular disease and include:
- Acute stroke thrombectomy: new technology that allows removal of clots in the brain through small catheters, or tubes
- Brain aneurysm treatment: using coils, stents or flow-diverters (such as the pipeline embolization device)
- Brain arteriovenous malformation/fistula (AVM/F) treatment: using liquid embolic agents (such as Onyx or n-BCA)
- Tumor embolization: using polyvinyl alcohol (PVA) particles
- Carotid (or intra-cranial) stenosis treatment: using micro-balloons and stents
Certain strokes originating from carotid artery disease, brain aneurysms, AVMs, and hypertensive hemorrhages benefit greatly from surgical interventions. Using the most advanced surgical and microsurgical techniques available today, MedStar Health neurosurgeons perform:
- Surgical clipping of complex (ruptured and unruptured) brain aneurysms
- Surgical resection of arteriovenous malformations/fistulas
- CyberKnife radiation, which delivers concentrated beams of radiation from multiple positions while sparing healthy tissue
- Carotid stenosis treatment using a surgery to remove the plaque causing the narrowing
Our multidisciplinary group of experienced physical therapists, occupational therapists, speech therapists, and neurorehabilitation physicians provide comprehensive patient-centered rehabilitation therapies designed to maximize stroke recovery.