SSM Health Neurosciences stroke centers offer the most advanced treatments for stroke. When every second counts, our experienced team of neurologists, neuro-interventionists, neurosurgeons, stroke nurse practitioners, stroke coordinators, ER physicians, radiologists, dedicated nurses and clinicians work together to deliver life-saving treatment.
Initial treatment for a stroke varies depending on whether it’s caused by a blood clot (ischemic
) or by a ruptured blood vessel in the brain (hemorrhagic
). Since each type of stroke has a different type of treatment, it is very important for the physician to determine the cause of the stroke, as well as the location, as quickly as possible.
Before starting treatment, your doctor will use a computed tomography (CT) scan of your head and possibly magnetic resonance imaging (MRI) to diagnose the type of stroke you’ve had and to assess the amount of brain damage. Initial treatment focuses on restoring blood flow for an ischemic stroke or controlling bleeding for a hemorrhagic stroke.
The window of opportunity to prevent significant loss of ability from stroke is several hours. But thanks to medical advances, that window is opening wider than ever. In fact, it is now possible to reverse a stroke with state-of-the-art equipment at the SSM Health Neurosciences.
"Time is Brain"
"Time is brain" is a simple, but accurate description of how vitally important it is to seek immediate medical treatment upon onset of stroke symptoms.
Treatment may include clot-busting medication or other interventions. The American Stroke Association has issued guidelines saying that patients can benefit from the clot-busting drug, tPA (tissue plasminogen activator), or thrombolytic drugs up to 4.5 hours after stroke symptoms begin. The guidelines apply to most patients with ischemic stroke (more than 750,000 Americans suffer from strokes each year, and 80 percent are ischemic strokes). All of our SSM Health Neurosciences locations have the ability to administer tPA.
Unfortunately, for patients who do not come in within the recommended time window, tPA therapy injected through an IV traditionally has not been effective at opening up a clogged blood vessel.
SSM Health DePaul Hospital - St. Louis, SSM Health Saint Louis University Hospital and SSM Health St. Clare Hospital - Fenton offer neuro-interventional treatments for stroke, including biplane angiography suites that offer patients a larger window of time for life-saving treatment – up to 12 hours. If you present at another SSM Health hospital, you will be evaluated for this treatment and immediately transferred if you qualify.
Biplane technology produces sharp, continuous snapshots inside the blood vessel, enabling an interventional neurologist to maneuver a catheter through the arteries of the neck or brain. The high-speed X-rays compensate for unavoidable patient motion, even allowing 3-D images to be obtained when needed.
SSM Health neuro-interventionists are able to perform intra-arterial tPA administration in which a small micro-catheter is inserted through the artery to the clot. Using this procedure, the physician can inject clot-dissolving medicine directly at the site.
For patients who are ineligible for tPA or who fail to respond, specialists at SSM may be able to physically remove the clot lodged in a brain or neck artery. Enhanced imaging can be used to guide a tiny corkscrew-shaped device inside a catheter through the blood vessel to the blockage, where it can grab and remove the clot.
These and other advances have been made possible through use of biplane angiography.
An Overview of Treatment Options
Emergency Treatment with Medications
Minimally Invasive Procedures
- Tissue plasminogen activator (tPA). Thrombolytic drugs or clot-busters help re-establish cerebral blood flow by dissolving clots. Injected through an IV (intravenous line), the clot-busting drug tPA can significantly reduce the effects of ischemic stroke and reduce permanent disability. To be effective, thrombolytic therapy cannot be started later than 4.5 hours from the time symptoms began. This means that people with unclear time of symptom onset may not be eligible for thrombolytic treatment under established protocols. The administration of tPA carries some risks, but its benefits outweigh them when an experienced doctor uses it properly.
- Antiplatelets. Platelets in the blood have a normal function of helping to form clots to stop bleeding, such as when you have a cut. But with a stroke, clots need to be prevented, so antiplatelet medications may be given to keep the blood flowing. The most commonly used antiplatelet agents are aspirin, Plavix and Aggrenox. Before antiplatelets are given, your doctor will ask you for information about conditions that might increase your risk of bleeding.
- Anticoagulants. Often called blood thinners, anticoagulants may be prescribed by physicians following a stroke, especially if you suffer from a condition such as atrial fibrillation. By reducing the ability of the blood to clot, they may help to keep blood vessels open and delivering oxygen and nutrients to brain cells.
- Endovascular Therapy. For patients who are ineligible for tPA or who fail to respond, specialists at SSM Health may be able to physically remove the clot lodged in a brain or neck artery, using minimally invasive procedures. Enhanced biplane imaging can be used to guide a tiny corkscrew-shaped clot retrieval device inside a catheter through the blood vessel to the blockage, where it can grab the clot.
- Carotid Stenting. Carotid artery stenosis (narrowing) causes as many as one in five strokes. Traditional treatment (see Carotid Endarterectomy) involves open surgery to clear the narrowed arteries of plaque. SSM Health neuro-interventionists offer a non-surgical alternative in carotid angioplasty and stenting to widen narrowed arteries. These specialists maneuver a balloon-tipped catheter into the obstructed area of the artery. The balloon is inflated, compressing the plaque against the artery walls. A metallic mesh tube (stent) is usually left in the artery to prevent recurrent narrowing. This is a wonderful advance for older patients who may not tolerate invasive surgery to open a carotid (neck) artery.
A hemorrhagic stroke occurs when a blood vessel bursts inside the brain. This type of stroke accounts for about 15 percent of all strokes. Hemorrhagic stroke occurs when a weakened blood vessel or aneurysm ruptures and bleeds into the surrounding brain. The blood pools and puts pressure on and damages the surrounding brain tissue, causing dangerous swelling.
A ruptured vessel usually results from an aneurysm, a ballooning of a weakened section of a vessel, or from an arteriovenous malformation (AVM), a cluster of abnormally formed blood vessels.
There are two types of hemorrhagic strokes: intracerebral hemorrhage (bleeding in the brain) and subarachnoid hemorrhage (bleeding in the area between the brain and tissues that cover the brain).
Hemorrhagic stroke is most often associated with high blood pressure (hypertension), which stresses the artery walls until they break. High blood pressure is a major risk factor for stroke and should be managed with medication and lifestyle changes.
Hemorrhagic stroke treatment
Aneurysm clipping. If the hemorrhagic stroke is due to a ruptured brain aneurysm, a neurosurgeon can place a tiny metal clamp at the base of the aneurysm to stop the bleeding. This procedure requires an open brain surgery called a craniotomy. Non-surgical coiling is another treatment option available through SSM Health Neurosciences.
SSM Health Rehabilitation & Hospital offers specialized rehabilitation and medical care for stroke patients through the Center for Neurological Recovery. Learn more.