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
Types & Treatments
Ischemic Stroke and Treatment
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:
Thrombotic strokes. These strokes are caused by a blood clot that develops in the blood vessels
inside the brain.
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
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:
- Intracerebral hemorrhage. This is bleeding from the small blood vessels
within the brain.
- 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 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.