Stroke Procedures and Treatment Information
Alteplace (tPA)
If you know anyone who has suffered from a stroke, you might be aware of one of the more common treatments for stroke: the clot-busting drug called tPA. This treatment works by dissolving the blood clot and improving blood flow to the part of the brain being deprived of blood.
Arteriogram
An arteriogram is a procedure that produces an image of your arteries. During the procedure, your doctor will use contrast material, or dye, and X-rays to observe the flow of blood through your arteries and note any blockages.
This procedure, also known as an angiogram, can be done on many different parts of your body. The terms “arteriogram” and “angiogram” (and the related “arteriography” and “angiography”) aren’t specific to a particular part of the body. These terms simply refer to a particular method of observing your arteries.
Coiling
Endovascular coiling is a procedure performed to block blood flow into an aneurysm (a weakened area in the wall of an artery). Endovascular coiling is a more recent treatment for brain aneurysms; it has been used in patients since 1991.
Endovascular coiling is a minimally invasive technique, which means an incision in the skull is not required to treat the brain aneurysm. Rather, a catheter is used to reach the aneurysm in the brain.
During endovascular coiling, a catheter is passed through the groin up into the artery containing the aneurysm. Platinum coils are then released. The coils induce clotting (embolization) of the aneurysm and, in this way, prevent blood from getting into it.
Carotid Stents
Carotid angioplasty is a non-surgical procedure performed after the diagnostic angiogram. The carotid angioplasty procedure can be performed the same day as the diagnostic angiogram or days or weeks after the angiogram.
During angioplasty, a balloon catheter is guided to the area of the blockage or narrowing. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls to improve blood flow.
During the angioplasty procedure, a carotid stent (a small, metal mesh tube) is placed inside the carotid artery at the site of the blockage and provides support to keep the artery open.
For patients who meet certain eligibility criteria, carotid stenting offers a less invasive approach than carotid endarterectomy, the traditional surgical treatment for carotid artery blockages. Carotid stenting can be performed while the patient is awake, reducing recovery time.
Embolization
Treatment of AVM or aneurysm involves the injection of glue or other nonreactive liquid adhesive material into the AVM or aneurysm in order to block blood flow. When there is no longer blood passing through, there is no further risk of bleeding.
Thrombectomy
When a stroke patient arrives for treatment, tPA is usually delivered directly to the site of the clot. After administering tPA, stroke physicians use advanced neuro-imaging to evaluate the patient’s brain. If tPa alone does not dissolve the clot and restore blood flow, and the patient is a good candidate, mechanical thrombectomy is the next step.
During the mechanical thrombectomy:
- A catheter is threaded into an artery in 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 “retrieved” – or pulled backwards – which removes the clot.