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Acute Stroke Therapy: Treatment of a Brain AttackAn acute stroke (brain attack) is very similar to a heart attack in that a blood clot suddenly blocks an important blood vessel feeding the brain. If that blood clot can be quickly dissolved, the devastating effects of the stroke often can be partially or totally relieved, and blood flow is restored to that part of the brain. The good experience of rapidly treating heart attacks with clot-busting medicines has led to the same approach in brain attacks. A very effective therapy, similar to the treatment of heart attack, is now available for acute stroke. Intravenous administration of tissue plasminogen activator (t-PA) within the first three hours of stroke symptoms has been shown to be very effective. Intravenous Clot-Busting TherapyA large clinical trial (NINDS trial) has shown doctors what they have felt intuitively for years - that by dissolving blood clots to the brain early, they often can improve quality of life in stroke patients. This relatively new clot-buster medicine (t-PA) has its best effect when given intravenously within the first three hours of stroke symptoms. In fact, the sooner it is given the better. Catheter-Directed TherapyIf a patient comes to the emergency room after three hours of symptoms, another form of therapy has been shown to be effective. This therapy is performed by administering the new clot-buster medicine (t-PA) through a catheter that is advanced from the groin directly into the brain and the offending blood clot. This often allows doctors to reverse the effects of the stroke. This has been shown to be effective up to six hours after stroke symptoms have begun. More specifically, using x-ray guidance, a doctor can guide a thin, hollow plastic tube from the groin directly into the blood clot and hopefully dissolve it by infusing only a small amount of the clot-busting drug. ConclusionIn conclusion, it can be stated that the sooner a blood clot is dissolved in the brain the better. If a stroke patient comes to the emergency room immediately after symptoms occur, the emergency room doctor and neurologist can administer t-PA intravenously within the first three hours of symptoms. However, if three hours of symptoms already have elapsed, then an x-ray guided angiogram and catheter-directed administration of t-PA often can be performed. This catheter-directed treatment has been shown to work well up to six hours after stroke symptoms occur. After six hours the brain often has suffered irreversible damage and these new clot-buster drugs are not recommended. At the Colorado Neurological Institute (CNI) both the intravenous clot-buster therapy (hours 1-3) and the catheter-directed therapy (hours 4-6) are available. Since no aggressive therapy is currently available after six hours of stroke symptoms have elapsed, it is important to come immediately to your local emergency room when stroke symptoms occur and ask about t-PA therapy.
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