Stroke Treatment Options Available at UPMC
When a large artery is blocked or occluded, advanced therapies are used to restore blood flow and help improve outcomes. Examples of advanced therapies include:
Intra-arterial clot-dissolving drugs
Clot-dissoliving drugs are given within three hours of the onset of symptoms. Tissue plasminogen activator (tPA) is given through a vein after the doctor has confirmed the stroke's cause, and there is no evidence of bleeding.
Mechanical clot removal devices to loosen and remove clots.
During a mechanical clot removal procedure, a catheter is threaded into an artery at 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 finally “retrieved” — pulled backwards — which removes the clot. Learn more about mechanical clot removal.
Intra-arterial thrombolytic treatment
Uses a long tube threaded through a blood vessel and into the brain to deliver clot-dissolving drugs, such as tPA, to the site of a blood clot causing a stroke. Because this method delivers a relatively high dose directly to the clot, it may be more effective and cause fewer side effects than delivering these medications to the whole body.
Neural implantation for stroke
An investigational therapy first performed at UPMC, this therapy uses minimally invasive surgery to place engineered nerve cells in stroke-damaged areas of the brain. UPMC studies of neural implantation have provided the first preliminary evidence that implanted cells can grow and take the place of nerve cells killed by a stroke.
Surgery may be performed following a stroke or transient ischemic attack (TIA) to prevent a recurrence.
- Consultation with a neurosurgeon may be needed if there are blocked blood vessels, extreme swelling of the brain tissue, or bleeding into the brain. Neurosurgeons concentrate on surgically bypassing and opening blocked vessels threatening the brain, as well as controlling bleeding and swelling in some types of hemorrhagic strokes.
- Carotid endarterectomy removes fatty deposits from a carotid artery, a major artery in the neck that leads to the brain.
- Extracranial/intracranial bypass reroutes the blood supply around a blocked artery using a healthy scalp artery.
Interventional treatments are for patients who present with stroke outside of the window for IV tPA or who are not able to receive the treatment due to a medical condition or medications they take. This treatment involves a procedure similar to a cardiac catheterization. A specially trained stroke doctor may suggest an interventional procedure in which catheters are inserted through the groin and navigated up to the arteries in the brain.
Several options for treatment are available; these are referred to as intra-arterial therapies and include:
- Injection of clot busting medication.
- Use of devices to mechanically remove the clot that is blocking an artery.
- Stent or balloon angioplasty to open blocked arteries
Additional stroke therapies
Additional therapies for treating stroke include:
- Control blood pressure.
- Reduce the chance of additional clot formation (aspirin or similar medications).
- Reduce brain swelling.
- Correct irregular heart rhythm.
Learn more about UPMC Stroke Institute research.