How We Treat Strokes
When a stroke happens, the brain damage that occurs can set off a cascade of other complications. That's why it's so important to treat a stroke as soon as possible. NewYork-Presbyterian is home to several stroke centers with the specialized expertise needed to quickly evaluate patients with stroke symptoms and treat them promptly using state-of-the-art therapies that optimize recovery. We have advanced imaging, the latest treatments, and a team of specially trained doctors - all available onsite. Our team determines the type of stroke and its severity, and customizes a plan of care for each of our patients.
Care for Ischemic Stroke
- Tissue plasminogen activator (tPA), a clot-busting drug for ischemic strokes (strokes due to a blockage or a clot in a blood vessel), is effective when given within four-and-a-half hours of the onset of stroke symptoms in people who do not have bleeding in the brain. At NewYork-Presbyterian, we have made significant strides in administering tPA rapidly to ischemic stroke patients who arrive in our Emergency Departments. This is critical as faster time to treatment is associated with better neurologic outcomes.
- A second stroke may be prevented using medications such as blood thinners, statins, and blood pressure medications.
- Minimally invasive treatment: Endovascular treatment is used for ischemic strokes that do not resolve with tPA, or in patients for whom tPA is no longer a treatment option. We use "mechanical clot extraction," inserting a special device through a catheter (flexible tube) advanced to the site of the blockage to remove the clot and restore blood flow. The latest studies suggest that combining tPA with endovascular treatment may be better for some patients than using tPA alone.
- Prevention of a second stroke using surgery: We may remove clots or plaque in the carotid arteries supplying blood to the brain, reroute the blood supply to get around an obstruction, or insert a stent to reduce the risk of a second stroke.
Care for Hemorrhagic Stroke
- Protecting brain tissue: To enhance healing and recovery for our patients with hemorrhagic stroke (bleeding in the brain), our team works together to control high blood pressure, normalize blood clotting, control brain swelling, enhance the flow of oxygen-rich blood to brain tissue near the injury, and regulate brain temperature to normal or below-normal levels to protect brain tissue.
- Traditional surgery: For our patients with large brain hemorrhages, we perform surgery to relieve pressure in the skull caused by bleeding. If the stroke resulted from a weakened area in a blood vessel wall (an aneurysm) or a defective blood vessel, our neurosurgeons repair these areas to prevent further strokes. They may also be able to redirect blood flow to other vessels that supply blood to the same region of the brain.
An Early Start on Rehabilitation
While recovering from a stroke, our patients benefit from a rehabilitation team that includes physical therapists, occupational therapists, speech therapists, recreational therapists, and physicians who are fellowship-trained in neurological rehabilitation. Together, the members of the team help our patients:
- Regain lost function
- Build strength and endurance
- Improve communication (for patients who have lost some of the ability to speak and gesture)