Stroke

A stroke is a "brain attack". It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.

How a person is affected by their stroke depends on where the stroke occurs in the brain and how much the brain is damaged. For example, someone who had a small stroke may only have minor problems such as temporary weakness of an arm or leg. People who have larger strokes may be permanently paralyzed on one side of their body or lose their ability to speak. Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability.

Stroke By The Numbers

• Each year nearly 800,000 people experience a new or recurrent stroke.
• A stroke happens every 40 seconds.
• Stroke is the fourth leading cause of death in the U.S.
• Every 4 minutes someone dies from stroke.
• Up to 80 percent of strokes can be prevented.
• Stroke is the leading cause of adult disability in the U.S

HEMORRHAGIC STROKE

A brain aneurism burst or a weakened blood vessel leak (hemorrhagic) is one of two types of stroke.  While the least common of the two types of stroke it most often results in death.

ISCHEMIC STROKE

A blood vessel carrying blood to the brain is blocked by a blood clot (ischemic) is one type of stroke. Learn more about the types of ischemic stroke.

WHAT IS TIA?

When blood flow to part of the brain stops for a short period of time, also called transient ischemic attack (TIA), it can mimic stroke-like symptoms. These appear and last less than 24 hours before disappearing.  Learn more about the signs, your risk, and TIA management.

STROKE FACTS

Although stroke is the fourth leading cause of death in America and a leading cause of adult disability, many myths surround this disease. Test how much you know about stroke today

The good news is that 80 percent of all strokes are preventable. It starts with managing key risk factors, including high blood pressure, cigarette smoking, atrial fibrillation and physical inactivity. More than half of all strokes are caused by uncontrolled hypertension or high blood pressure, making it the most important risk factor to control. 

Medical treatments may be used to control high blood pressure and/or manage atrial fibrillation among high-risk patients. Those medicines include:

• Anticoagulants/Antiplatelets
  Antiplatelet agents such as aspirin and anticoagulants, such as warfarin, interfere with the blood's ability to clot and can play an important role in preventing stroke. Read more about anticoagulants.  
   
• Antihypertensives
  Antihypertensives are medications that treat high blood pressure. Depending on the type of medication, they can lower blood pressure by opening the blood vessels, decreasing blood volume or decreasing the rate and/or force of heart contraction. Learn about the types of antihypertensives.

Additionally, when arteries show plaque buildup or blockage, medical procedures may be needed. Such as:

• Carotid Endarterectomy
  Carotid endarterectomy, also called carotid artery surgery, is a procedure in which blood vessel blockage (fatty plaque) is surgically removed from the carotid artery. 
  View a detailed illustration of carotid endarterectomy (opens in new window).
   
• Angioplasty/Stents
  Doctors sometimes use balloon angioplasty and implantable steel screens called stents to treat cardiovascular disease and help open up the blocked blood vessel.
  
  If you’re having a stroke, it’s critical that you get medical attention right away. Immediate treatment may minimize the long-term effects of a stroke and prevent death.

When a Stroke Occurs: Quick Stroke Treatment Can Save Lives

There are two types of strokes: hemorrhagic or ischemic. An ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases. A hemorrhagic stroke occurs when a weakened blood vessel ruptures and spills blood into brain tissue. The most common cause for the rupture is uncontrolled hypertension (high blood pressure). There are two other types of weakened blood vessels that also cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs). Treatment differs depending on the type of stroke.

Ischemic Stroke Treatment

tPA, the Gold Standard

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(and up to 4.5 hours in certain eligible patients), 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.

Endovascular device removing the clot*

Endovascular Procedures 
Another treatment option is an endovascular procedure* in which specially trained doctors try removing the blood clot by sending a catheter to the site of the blocked blood vessel in the brain. Sometimes these procedures involve tPA being administered directly into the blood clot (called intra-arterial treatment) to help dissolve the blockage. In other procedures, the doctor may attempt to remove the clot. Researchers are still conducting research to determine the best clinical protocols for endovascular procedures.  
*Note: Patients must meet certain criteria to be eligible for this procedure.

Image courtesy of Covidien.

Hemorrhagic Stroke Treatment

Endovascular Procedures 
Endovascular procedures may be used to treat certain hemorrhagic strokes similar to the way the procedure is used for treating an ischemic stroke. These procedures are less invasive than surgical treatments, and involve the use of a catheter introduced through a major artery in the leg or arm, then guided to the aneurysm or AVM; it then deposits a mechanical agent, such as a coil, to prevent rupture.

Surgical Treatment
For strokes caused by a bleed within the brain (hemorrhagic stroke), or by an abnormal tangle of blood vessels (AVM), surgical treatment may be done to stop the bleeding. If the bleed is caused by a ruptured aneurysm (swelling of the vessel that breaks), a metal clip may be placed surgically at the base of the aneurysm to secure it.