Types of Stroke and Treatment

We are a leader in successful, minimally-invasive treatment of stroke and one of Southern California’s hospitals to offer patients rapid access to a state-of-the-art Neurointerventional Lab and fellowship-trained interventional neuroradiologists. Advanced imaging allows the interventionalists to quickly and accurately visualize, diagnose and treat stroke without the need for surgery. Our specialists routinely remove clots, prevent an aneurysm from bursting, and place stents to maintain blood flow – even in areas of the brain that are impossible to reach with open surgery.

The expertise of our neurointerventional team allows us to go beyond simply stopping a stroke in its tracks – and actually prevent or reverse its effects – while leaving behind incisions small enough to be covered by a Band-Aid.

If surgery is needed, St. Jude Medical Center is also home to the nation’s most advanced neurosurgical capabilities, combining intraoperative MRI with sophisticated navigation abilities. This new technology – in the hands of our highly experienced neurosurgeons – is creating new levels of accuracy and precision, while making surgeries less invasive with fewer complications.

Stroke, also called brain attack, occurs when the blood supply to the brain is blocked, preventing oxygen and nutrients from reaching part of the brain. Cells in this area begin to die and functions controlled by this part of the brain are lost. Stroke can be caused by a thrombosis (blood clot), embolism (blockage) or hemorrhage (bleeding).

If you suspect you or someone with you is experiencing a stroke, call 911 immediately.

Types & Treatments

Ischemic Stroke and Treatment

Ischemic Stroke

Ischemic strokes account for 87 percent of all strokes and are caused by blockage of an artery. When blood carrying oxygen and nutrients to the brain is blocked, brain cells begin to die within minutes. Ischemic strokes can be further divided into two groups:

  1. Thrombotic strokes. These strokes are caused by a blood clot that develops in the blood vessels inside the brain.
  2. Embolic strokes. These strokes are caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to one of the blood vessels in the brain through the bloodstream.

View a detailed animation of an Ischemic Stroke

Ischemic Stroke Treatment

The only FDA approved treatment for ischemic strokes is tissue plasminogen activator (tPA, also known as IV rtPA, given through an IV in the arm). tPA works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. If administered within 3 hours, tPA may improve the chances of recovering from a stroke. A significant number of stroke victims don’t get to the hospital in time for tPA treatment; this is why it’s so important to identify a stroke immediately.

tPA can be given by IV, usually through a vein in the arm, or injected directly to the site of the clot. This intra-arterial tPA procedure, a fast and more precise way to get tPA to the blockage, is performed by an interventional neuroradiologist, who inserts a thin, flexible catheter into an artery and threads it to the blood clot in the brain. Intra-arterial therapy can be effective even up to 8 hours after the onset of symptoms, extending the potential treatment window.

Benefits of tPA include:

  • Less neurological damage
  • Faster recovery
  • Shorter hospital stay

If tPA alone does not dissolve the clot and restore blood flow, and the patient is a good candidate, mechanical thrombectomy is the next step. This procedure is performed by highly-trained interventional neuroradiologists. During the mechanical thrombectomy, a catheter is threaded into an artery in the groin and up through the neck, until it reaches the blood clot causing the stroke. Using X-ray guided imaging, a stent retriever is inserted into the catheter. The stent reaches past the clot, expands to stretch the walls of the artery so blood can flow, and is “retrieved” - or pulled backwards - which removes the clot.

Hemorrhagic Stroke and Treatment

Hemorrhagic Stroke

Only about 13 percent of all strokes are hemorrhagic, caused by an aneurysm, or other blood vessel abnormality that has ruptured and is bleeding. When there is bleeding into the brain, cells and tissues do not receive enough oxygen and nutrients. Hemorrhagic strokes can be divided into two groups:

  1. Intracerebral hemorrhage. This is bleeding from the small blood vessels within the brain.
  2. Subarachnoid hemorrhage. This is bleeding in the subarachnoid space (the space between the brain and the membranes that cover the brain). Most of this type of bleeding is caused by an aneurysm.

Hemorrhagic Stroke Treatment

Every stroke patient is treated individually. No two aneurysms are the same, and each patient receives unique treatment based on their needs. While tPA works well for ischemic strokes, hemorrhagic strokes require a different approach. Our specialists treat hemorrhagic stroke patients with the most technically advanced treatments available.

Coiling is a minimally invasive endovascular procedure performed to treat an aneurysm - a balloon-like bulge of an artery wall. As an aneurysm grows, it thins and weakens. It can become so thin that it leaks or ruptures, releasing blood into the space around the brain. This bleeding is called a subarachnoid hemorrhage (SAH) and is life threatening. During coiling, tiny coils are packed into the aneurysm to promote blood clotting and close off the aneurysm. Coils accomplish from the inside what a surgical clip would accomplish from the outside: they stop blood from flowing into the aneurysm but allow blood to flow freely through the normal arteries.

St. Jude’s specialized Neurointensive Care Unit is staffed with Southern California’s most qualified team of Intensivists board certified in Neurocritical Care. These full-time, hospital-based critical care physicians specialize in advanced stroke management and have developed best practice guidelines to create the best possible outcomes. Our Critical Care Unit also feature highly-trained nurses with extensive training and experience in monitoring and caring for stroke patients.

View a detailed animation of a Hemorrhagic Stroke

Transient Ischemic Attacks

Transient Ischemic Attacks or TIA

While Transient Ischemic Attack (TIA) is often labeled a “mini-stroke,” it is more accurately characterized as a “warning stroke,” a warning you should take very seriously. About one-third of the people who experience a TIA go on to have a stroke within a year.

A TIA is caused by a clot; the only difference between a stroke and TIA is that the blockage is transient (temporary). TIA symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes; the average is about a minute. When a TIA is over, it usually causes no permanent injury to the brain.

View a detailed animation of a TIA

Recurrent Strokes

Recurrent Strokes

Recurrent strokes occur in about 25 percent of stroke victims within their lifetime, and about a third of the individuals who experience a TIA will have a stroke within a year. The likelihood of severe disability and death increases with each recurrent stroke. About three percent of stroke patients have a second stroke within 30 days of their first stroke, and about one-third have a second stroke within two years.

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