This is an abbreviated version of the complete article.*
Interventional stroke treatments deliver clot-dissolving medication to the site of a blood clot in the brain.
Only patients who have ischemic strokes, or strokes that are associated with a lack of oxygen to the brain caused by blocked arteries, are eligible for interventional stroke treatment. The procedure is not used for patients who have bleeding (hemorrhagic) strokes.
Interventional stroke treatments are most effective when used before large areas of brain have died.
These procedures are offered only at a limited number of centers nationwide.
In interventional stroke treatment, a catheter is advanced to the site of a blood clot from an access point in the groin.
Interventional stroke treatments are treatments that use catheters (long, thin tubes) or microcatheters to unblock a blood vessel in the brain soon after a stroke occurs. Also known as intra-arterial stroke therapy, this treatment delivers clot-busting medication to the site in the brain where the blockage is located.
The goal of interventional stroke therapy is to restore blood flow to brain tissue as quickly as possible to prevent brain damage.
WHO IS ELIGIBLE?
Patients who have had a recent ischemic stroke are eligible for interventional stroke therapy. For treatment to be effective, it must be provided within at least 12 hours, preferably within 3 to 6 hours of the onset of the stroke.
Circumstances that exclude patients from the treatment include:
A stroke or head trauma within the past 3 months;
Major surgery within the last 2 weeks;
Uncontrollable high blood pressure;
Blood clotting problems or taking anticoagulant medications.
Effective interventional stroke treatment requires speedy diagnosis of a stroke. Knowing the signs of stroke is important, the most common of which are:
Sudden numbness or weakness of face, arm or leg, especially on either side of the body;
Sudden confusion, trouble speaking or difficulty understanding speech;
Sudden trouble seeing out of one or both eyes;
Sudden dizziness, trouble walking, or loss of balance or coordination; and
Sudden severe headache that has no known cause.
Tests physicians use to diagnose stroke include:
Chest x ray;
Computed tomography (CT) scan; and
Magnetic resonance angiography (MRA).
To locate a clot, physicians will perform an arteriogram.
WHAT TO EXPECT
Interventional stroke treatment aims to deliver thrombolytic, or clot-busting, drugs directly to the clot inside the brain.
The physician steers a catheter through the arterial system to the large arteries of the brain. The physician may then insert smaller instruments known as microcatheters through the guide catheter.
The physician then delivers clot-busting drugs through the microcatheter to break up the clot, usually tissue plasminogen activators (t-PA). The drug delivery may take minutes, or the drugs may be delivered over a period of hours.
Once the clot has been dissolved or if it cannot be dissolved further, the physician will discontinue the medication and remove the catheter.
POST-TREATMENT GUIDELINES AND CARE
After the procedure, patients typically receive:
Painkillers (if necessary).
The arm or leg into which the medication was inserted should be kept straight for several hours afterward. The patient is discharged once any bleeding from the insertion site has stopped and vital signs are judged to be normal.
During recovery, the patient may experience:
The patient should inform the physician of persistent back pain or nausea, because they indicate internal bleeding.
Complications from interventional stroke therapy include:
Hemorrhage, or bleeding, in the brain;
Recurrence of stroke.
Medical Review Date: October 20, 2009
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