Comprehensive Stroke Center
Treatment for Ischemic Strokes
Treatment for stroke depends primarily on the kind of stroke you have experienced.
The team of experienced stroke specialists at Wake Forest Baptist Health includes leaders in the field of stroke treatment. Our doctors are well versed in the latest research, clinical trials, and novel procedures – and we have the resources to offer these treatments to our patients. Our neuro-ultrasound laboratory, where we assess the stroke, is one of the most advanced in the region. Our team will develop an effective treatment plan for your condition based on the most current and proven medical information and technology available.
Advanced Ischemic Stroke Treatment
An ischemic stroke occurs when a blood clot forms in an artery that supplies blood to the brain. Strokes may also occur when arteries fill with plaque and narrow, making it difficult for blood to travel through them. Treating an ischemic stroke requires removing or dissolving the clot and preventing new ones from developing, as well as widening the arteries.
For acute ischemic disease, these treatments include:
Clot-Busters – Tissue Plasminogen Activator (tPA)
Tissue Plasminogen Activator (tPA) is a medication injected into the bloodstream that dissolves blood clots in the arteries that supply blood to the brain. It’s a lot like a liquid clog remover that unclogs stopped-up drain pipes. Only instead of plumbing pipes, it works on arteries.
TPA is effective for patients who receive it within a few hours of their stroke and who do not have any additional bleeding.
There are two ways to administer tPA:
- Intravenous tPA – You receive tPA through an intravenous (IV) line that injects the medication into your bloodstream. It then travels to the site of the blood clot, locks onto the clot, and breaks it up or dissolves it. This method needs to be administered within about three hours after the stroke.
- Intrarterial tPA – In this method, one of our highly trained neurovascular specialists will thread a thin tube through an artery in your groin area directly to the blood clot. Your specialist will administer tPA directly to the blood clot to break it up or dissolve it. This method is faster at attacking the blood clot than intravenous tPA, and so can still be effective within up to about six hours after a stroke.
Clot Retrieval and Disruptive Devices
TPA may not work for all patients, especially for those who arrive too late for treatment with medication. At Wake Forest Baptist, we are trained in using highly advanced surgical methods to remove blood clots. Using a combination of imaging technology and devices, our stroke team can surgically take out or break up blood clots in the arteries. These may include
- Merci retrieval device – With this tiny corkscrew shaped device, the surgeon can go from the patient’s groin to the clot in the artery in the head. By engaging the clot in the corkscrew, the surgeon can pull it out and restore blood flow to the brain.
- Penumbra aspiration device – Using the same route to the brain—from the groin to the artery in the head—this tiny catheter is placed in the clot blocking the artery and is suctioned out. This opens the artery up again.
For chronic ischemic disease, our stroke specialists are highly skilled in a variety of surgical techniques, including:
- Intracranial angioplasty and stenting – This minimally invasive procedure can open up narrowed or blocked arteries that supply blood to the brain. The procedure helps blood flow more freely. Using imaging technology, our expert team will insert a thin tube into the groin area and guide it to the targeted artery. In the angioplasty procedure, the team will insert a tiny balloon into the artery to slowly widen it. In some cases, the team will also insert a stent into the artery. A stent is a small mesh tube that helps prevent arteries from becoming blocked again.
- Extra-cranial-Intra-cranial (EC-IC) bypass – This is a surgical procedure that helps improve blood flow to the brain by connecting a healthy artery in the scalp to the area of the brain that needs a better supply of blood. Wake Forest Baptist is the only hospital in the area to offer this rare procedure.
Preventing Strokes by Treating Carotid Artery Disease
The carotid arteries, which are located in the neck, are important sources of blood for the brain. If these arteries become clogged with plaque and fat, they can narrow. This makes it harder for blood to flow freely and so can lead to strokes. The Wake Forest Baptist stroke team offers procedures that help keep the carotid arteries healthy and prevent future strokes or mini-strokes (TIAs).
These procedures include:
- Carotid endarterectomy – In this surgical procedure, your team will open up a blocked carotid artery in your neck to clean out fat and plaque buildup that can lead to stroke.
- Carotid artery angioplasty and stenting – This minimally invasive procedure widens the carotid artery to help prevent strokes. Our expert team will insert a thin tube in to the groin area and use imaging technology to guide it to the carotid artery. In the angioplasty procedure, the team will insert a tiny balloon into the artery to slowly widen it. This is followed by insertion of a stent into the artery. A stent is a small mesh tube that helps prevent arteries from becoming blocked again.
Managing Brain Swelling With Decompressive Hemicraniectomy
In some cases, strokes can cause the brain to swell and push up against the skull, causing an increase in pressure in the skull. This is called elevated intracranial pressure, and it can cause significant brain damage, or even death. The stroke team at Wake Forest Baptist is skilled at reducing brain swelling and intracranial pressure using a surgical procedure called decompressive hemicraniectomy once all non-surgical treatments have been used.
During this procedure, surgeons remove a significant portion of the skull to allow the brain to swell as much as possible. The brain is then allowed to return to normal size before the surgeons replace the removed piece of skull.
No matter what type of treatment our stroke specialists think is best for you or your loved one, we will walk you through the process, answer all your questions and help you with your transition into this new life. Learn more about stroke rehabilitation at Wake Forest Baptist.