Treatments for Stroke
The Mount Sinai Health System takes a multidisciplinary approach to treating stroke, bringing specialists in vascular neurology, neurosurgery, neuroradiology, emergency medicine, and rehabilitation together to provide you with the most prompt and comprehensive care possible. We are pioneering new approaches to the diagnosis and treatment of stroke that can significantly improve your chances for an optimal recovery.
With each new patient, we immediately contact our Stroke Center and prepare the patient for testing and treatment. To address a stroke, we must immediately open the blocked blood vessel, which should restore blood flow to the brain and stop further damage. We may also provide supportive care in the form of oxygen therapy and precautions to prevent choking.
We offer our stroke patients specialized facilities, including a neurocritical care unit with state-of-the-art monitoring for post-procedure care, and a dedicated, state-of-the art acute stroke unit for ongoing evaluation and management. Our patients continue treatment in one of the intensive care units, being closely watched before transferring to step-down units or a general floor. In addition, our patients begin work with speech, occupational, and physical therapists shortly after admission. The Stroke Team works closely with Rehabilitation to make sure the transition goes smoothly. Patients continue under the care of their Stroke Center neurologist even after discharged, providing critical continuity of care.
Medications for Stroke
We may use a type of medication called thrombolytics, which can rapidly dissolve blood clots. We often deliver these medications intravenously or even more directly into the artery with the blood clot. For maximum effectiveness, we must give these medications within hours of the start of symptoms. We may also recommend other medications to lower the risk of blood clot formation, decrease blood pressure, or correct irregular heart rhythms, all with the hope of preventing future strokes.
Advanced Treatments for Stroke
We offer advanced treatments for stroke that can significantly improve your chances for an optimal recovery. These therapies are performed in conjunction with the Department of Neurosurgery and include:
- Intravenous alteplase: A clot-busting medication for acute ischemic stroke
- Embolization for brain aneurysms: A process that packs brain aneurysms (weakened areas of the arterial wall that may rupture) with coils so they no longer fill with blood
- Aneurysm clipping: A technique in which we place a surgical clip around the neck of a brain aneurysm to prevent blood from flowing into it
- Carotid Endarterectomy: A vascular surgery to remove blockages in the carotid artery
- Angioplasty/Stents: An endovascular option, whereby balloon angioplasty and implantable stents help keep arteries open
- Intra-arterial thrombolysis: A process using a catheter, inserted into one of the major blood vessels in the leg and guided by a special video, to inject a clot-dissolving agent into clots in the brain
- Stereotactic microsurgery: The use of sophisticated computer technology, cameras, and delicate instruments, to remove arteriovenous malformations
Rehabilitation after Stroke
If brain tissue was damaged during a stroke, rehabilitation can be an important part of your recovery, and we find that your recovery improves if you start a rehabilitation program as soon as possible.
Our specialists are skilled in providing rehabilitation care that includes the following:
- Physical therapy to help you regain as much movement as possible
- Occupational therapy to assist in everyday tasks and self-care
- Speech therapy to improve swallowing and speech challenges
- Psychological therapy to improve mood and depression and anxiety
Prevention of Recurrent Stroke
With help, you can often change many of the risk factors for stroke. Experts estimate that up to 80 percent of strokes can be prevented. Lifestyle changes that can help reduce your chance of getting a stroke include:
- Regular exercise
- A balanced diet of fruits, vegetables, whole grains, and fish
- Limiting qualities of salt and fat in foods
- Quitting smoking
- Drinking alcohol only in moderation
- Maintaining a healthy weight
- Following your doctor’s instructions regarding any medications you’re taking
Our Center’s neurologists work with a patient’s primary care physician to lower cholesterol levels or control blood pressure using various medications.
A Range of Care
The Stroke Center team is immediately contacted and preparations are made for testing. Clot-busting thrombolytics or tissue plasminogen activator (TPA) is given to select stroke patients, according to established medical guidelines.
Stroke patients continue treatment in one of the Center’s intensive care units, being closely monitored before transferring to step-down units or a general floor. In addition, they begin work with speech, occupational and physical therapists shortly after admission. The Stroke Team works closely with Rehabilitation to make sure the transition goes smoothly.
Most importantly, patients continue under the care of their Stroke Center neurologist even after discharged, providing critical continuity of care.
Intra-arterial Thrombolysis
Intra-arterial thrombolysis uses a catheter, inserted into one of the major blood vessels in the leg and guided by a special video system, to inject TPA or a similar clot-dissolving agent directly into clots in the brain.
Surgical Treatments
Surgical treatments include:
- Carotid Endarterectomy—a vascular surgery to remove blockages in the carotid artery.
- Angioplasty/Stents—an endovascular option, whereby balloon angioplasty and implantable stents are used keep arteries open.
- Inserting metal clips at the base or neck of an aneurysm to seal it off.
- Using catheters to place detachable platinum coils in aneurysms to prevent blood from entering it, eliminating the danger of hemorrhaging.
Stereotactic microsurgery, with sophisticated computer technology, cameras and delicate instruments, to remove arteriovenous malformations.
Rehabilitation and Prevention
After emergency treatment and when a stroke patient’s condition stabilizes, the Stroke Center focuses care on rehabilitation and preventing another stroke. Critical for success is controlling risk factors, such as high blood pressure, atrial fibrillation, high cholesterol and diabetes.
Stroke Center neurologists work with a patient’s primary care physician to control these conditions with medication, such as blood thinners, statins to lower cholesterol or various medicines to control blood pressure.
Starting a rehabilitation program as soon as possible increases a patient’s recovery. Lifestyle changes also reduce the risk of another stroke. They can include exercise, eating a more balanced diet and smoking cessation.
Depression can occur in people who have had a stroke, so patients also may be treated with medication if they show symptoms of this condition.
Risk Factors
Researchers estimate that approximately 50 percent of strokes can be prevented by lifestyle changes and reducing risk factors. Risk factors for a stroke include:
- High blood pressure or hypertension
- Diabetes
- High cholesterol
- Smoking
- Heart disease
- Carotid artery disease
- Poor diet
- Lack of exercise
- Obesity
Stroke Warning Signs
Learn to recognize common stroke symptoms. If you notice one or more of the following symptoms in yourself or another person, call 9-1-1 or your local emergency medical services number immediately. You must get to the nearest hospital emergency department, preferably one that has a “dedicated” stroke facility.
Warning signs of stroke include:
- Sudden numbness or weakness in the face, arm or leg, especially on one side of the body
- Sudden confusion and trouble speaking or understanding
- Sudden trouble with vision in one or both eyes
- Sudden difficulty walking, dizziness, and loss of balance or coordination
- Sudden severe headache
Not all these symptoms occur with every stroke but you must act quickly if you suspect you or someone is having a stroke. Early treatment is the most effective
A Life-Threatening Emergency
Every stroke is a life-threatening emergency. Time is critical. To increase your chances of minimizing a stroke’s impact, take immediate action:
- Recognize the warning signs and note the time when they first occur. Call 9-1-1 immediately. Tell the operator that you or the person you are with is experiencing stroke symptoms.
- Get early assessment and pre-hospital care by emergency medical service personnel.
- Tell emergency medical service personnel to take you to a “designated” hospital stroke center or emergency department equipped and staffed to diagnose and treat stroke.
- At the hospital, get a prompt evaluation by a stroke specialist and appropriate treatment to restore blood flow to the brain. Adhere to all follow-up care your stroke specialist recommends.