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Neurology and Neuroscience

How Strokes Are Treated

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When a stroke occurs, the brain suffers damage that can set off a cascade of related complications such as elevated pressure inside the skull, seizures, and fever, which amplify the brain's injury and lessen a patient's chance of a full recovery. Getting the best available care within the first 48 hours of a stroke can halt this cascade and is critical to making the best possible recovery. This care is best delivered at a primary stroke center, such as one of NewYork-Presbyterian's four campuses.

A drug called tissue plasminogen activator (tPA) is the first treatment for people with ischemic stroke. This clot-dissolving medicine is effective when given within four-and-a-half hours of the onset of stroke symptoms in patients who do not have bleeding in the brain.


Randolph S. Marshall, M.D., M.S., the Chief of the Stroke Division at NewYork-Presbyterian/Columbia University Medical Center, discusses what makes NYP a leading center for stroke care.

Patients with ischemic strokes that do not respond well to tPA (or who arrive at the hospital more than four-and-a-half hours after the onset of symptoms) may be treated with minimally invasive approaches, such as "mechanical clot extraction." During this procedure, the doctor inserts a special device through a catheter and advances it to the site of the blockage to mechanically remove the clot. Small doses of tPA can also be delivered through the catheter to help break up the clot.

A NewYork-Presbyterian neuroradiologist was part of the team that developed the Merci® device – the first FDA-approved clot retrieval system. Since then, even more effective clot retrieval devices have been developed and are now regularly used. Today, NewYork-Presbyterian doctors employ advanced endovascular approaches to treat some 60 patients a year with acute ischemic stroke.

Patients with hemorrhagic stroke receive immediate care to control brain swelling and to improve the flow of oxygen-rich blood in the brain. Patients with larger brain hemorrhages may need to undergo 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, neurosurgeons can repair these areas to prevent further strokes. They may also be able to redirect blood flow to other vessels that supply the same region of the brain. Our team works to control high blood pressure, normalize blood clotting, and provide neuroprotective approaches to enhance recovery in patients with hemorrhagic stroke.

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