Latest news with #ischemicstroke
Health Line
7 hours ago
- Health
- Health Line
A Complete Guide to Stroke Treatments
Key takeaways Treatment for stroke depends on whether it is an ischemic stroke, caused by a blocked artery, or a hemorrhagic stroke, caused by bleeding in the brain. FAST (Face, Arms, Speech, Time) is a useful acronym for quickly identifying stroke symptoms and the need for immediate medical attention. Following a stroke, preventive treatments and rehabilitation are important for improving cardiovascular health and regaining lost functions like coordination, speech, and balance. A stroke occurs when the blood flow to a specific part of your brain is cut off. When this happens, the cells don't get oxygen and begin to die, causing numerous symptoms. How a stroke affects you depends on the location in your brain where the stroke occurs. Evaluation and treatment for a stroke should begin as soon as possible. The quicker emergency treatment begins, the greater the chance of preventing lasting damage. Treatment depends on whether you're having an ischemic or hemorrhagic stroke. Act FAST to treat stroke Successful outcomes after a stroke depend on how quickly doctors can begin treatment. The acronym FAST (face, arms, speech, time) can help you quickly assess for stroke symptoms: F: Check for facial droop. A: Hold arms out. Does one drop downward? S: Is speech irregular, delayed, or absent? T: It's time to call 911 or your local emergency services if any of these symptoms are present. Emergency treatment for ischemic stroke Ischemic strokes are the most common kind of stroke. They occur when a blood clot blocks blood flow to your brain. Medications Medication treatment for this type of stroke must start within 3 hours (but up to 4.5 hours in selected cases) of the event, according to 2018 guidelines from the American Heart Association and the American Stroke Association. The primary treatment for ischemic stroke is tissue plasminogen activator (tPA), a powerful thrombolytic that breaks up blood clots blocking or disrupting blood flow to your brain. A healthcare professional will administer a tPA through a vein in your arm. Alteplase (Activase) is currently the only FDA-approved tPA for stroke, but healthcare professionals are increasingly using tenecteplase (TNKase) due to its success in clinical trials and cost-effectiveness. You may receive other medications, including: blood thinners like clopidogrel (Plavix) or warfarin (Coumadin) if you can't receive tPA aspirin within 24–48 hours after a stroke to reduce the risk of new blood clots statins to reduce the risk of future stroke Thrombectomy If drugs don't adequately break up the blood clot and if the stroke is acute or localized to one area, your doctor may use a catheter to access the clot and remove it manually. This is called a thrombectomy. They'll thread the catheter through your blood vessels toward the area where the clot is lodged. Your doctor can remove the clot either by a corkscrew-like device attached to the catheter or by using clot-busting agents administered through the catheter directly into the clot. Doctors can perform mechanical clot removals up to 24 hours after the appearance of stroke symptoms. Decompressive craniectomy A large stroke can lead to severe swelling in the brain. You may need surgery if drugs don't relieve the swelling. Decompressive craniectomy aims to relieve the buildup of pressure inside your skull before it becomes dangerous. For the procedure, a surgeon will open up a flap of bone in your skull in the area of the swelling. Once the pressure is relieved, the surgeon will return the flap. Emergency treatment for hemorrhagic stroke Hemorrhagic stroke occurs when a brain aneurysm bursts or a weakened blood vessel leaks. This causes blood to leak into your brain, creating swelling and pressure. Medications Unlike ischemic strokes, treatment for hemorrhagic strokes doesn't involve blood thinners. This is because thinning your blood would cause the bleeding in your brain to become worse. If you're already taking blood thinners, a doctor may administer drugs to counteract them. A doctor may recommend other medications to help treat hemorrhagic stroke or its complications, including: antihypertensives to lower your blood pressure vitamin K or medications to help stop bleeding in the brain antiepileptics if the stroke leads to seizures Surgery Depending on the damage to the vessel in your brain, you may need surgery after a hemorrhagic stroke. For surgery to be successful, the affected blood vessel must be in a location the surgeon can reach. Options for medical procedures after a hemorrhagic stroke include: Endovascular repair: Also known as coiling, this minimally invasive procedure involves threading a thin wire and catheter through your blood vessels into the aneurysm. The surgeon then releases a coil of soft platinum wire into the area, forming a net to prevent further bleeding. Aneurysm clipping: Clipping the aneurysm involves permanently installing a clamp to prevent it from bleeding further or bursting. As clipping is typically more invasive than coiling, doctors recommend it only when coiling isn't an option. Arteriovenous malformation (AVM) surgery: An AVM is a tangle of blood vessels that can burst. AVM surgery can remove or shrink this tangle, restoring proper blood flow. Decompressive craniectomy: Also used for ischemic strokes, this involves temporarily removing part of the skull to relieve pressure. Stereotactic radiosurgery: This noninvasive technique uses radiation therapy to repair blood vessels. While in hospital, you may require other treatments to help you in the early stages of recovery. These may include: a feeding tube, especially if you have dysphagia (difficulty swallowing) IV fluids, to prevent dehydration supplemental oxygen, if you have hypoxemia (low blood oxygen) nutritional supplements compression stockings, to prevent blood clots Preventive treatments following stroke After emergency procedures, your doctor will evaluate the health of your arteries and determine what needs to be done to prevent another stroke. Lifestyle changes Post-stroke preventive measures mainly focus on improving cardiovascular health. This might mean lowering your blood pressure and managing your blood sugar and cholesterol levels. Recommended lifestyle changes may include: getting regular exercise eating a heart-healthy diet taking medications such as aspirin quitting smoking if you do Carotid endarterectomy If you've had an ischemic stroke due to a blocked carotid artery, a doctor might recommend a carotid endarterectomy. The carotid arteries are the major blood vessels in the neck that supply blood to the brain. For this procedure, a surgeon will remove plaques and blockages from these arteries to improve blood flow and decrease the risk of future stroke. This surgery carries the risks associated with any surgery. There's also the risk that it may trigger another stroke if plaques or blood clots are released during the surgery. Surgeons use protective measures to help reduce these risks. Rehabilitation after a stroke Rehabilitation following a stroke depends on the extent of the damage and what part of your brain was affected. For instance, if the stroke occurred in the right side of your brain, you may need physical rehabilitation that focuses on walking up and down stairs, getting dressed, or bringing food to your mouth. The right side of the brain controls visual-spatial functions. You may need rehabilitation or corrective measures to also help with: coordination balance vision bowel or bladder control speech swallowing fine motor activities, such as writing or drawing Frequently asked questions What is the treatment for a TIA? A transient ischemic attack (TIA), or ministroke, results from a temporary blockage of blood flow to your brain. Having a TIA significantly increases your risk of an ischemic stroke. Treating TIA typically involves lifestyle changes and medications that reduce your risk of stroke. How long does a stroke last? There's no set time for how long stroke symptoms typically last. The duration of symptoms can depend on the type of stroke and the treatment received. For example, in a 2021 study of people who received endovascular surgery after an ischemic stroke, symptoms lasted an average of 6.8 hours. The researchers found that the longer symptoms persisted, the less likely it was doctors could restore blood flow. But stroke symptoms can last days to weeks or months. In some cases, symptoms and complications may never go away. How long does it take to recover from a stroke? Stroke recovery can take weeks to years. While some people make a full recovery, many experience permanent impairments. Research suggests that quicker treatment leads to better recovery and outcomes.
Medscape
6 days ago
- Health
- Medscape
What Is Lp(a), and When Should We Check It?
In this podcast, I'm going to talk about what we need to know about lipoprotein (a), or Lp(a), and atherosclerotic cardiovascular disease in primary care. Lp(a) is an important but underappreciated independent risk factor for atherosclerotic cardiovascular disease. As we all know, atherosclerotic cardiovascular disease is a chronic, progressive condition characterized by the accumulation of lipids, inflammatory cells, and other cells in arteries that results in the formation of atherosclerotic plaques. As these plaques build up and rupture, they cause partial or complete obstruction of blood flow, tragically leading to clinical events such as myocardial infarctions or ischemic strokes. I'm sure all of us in primary care can sadly recall individuals who have suffered heart attacks or strokes who appeared to be very healthy, with no obvious cardiovascular risk factors. We all know that elevated LDL cholesterol levels (or bad cholesterol) are a proven and direct cause of atherosclerotic cardiovascular disease, and it has been estimated that for each 1 mmol/L reduction in LDL cholesterol, there's a relative risk reduction of 23% for major cardiovascular events. Well, Lp(a) is an LDL-like particle that is an independent, genetically determined risk factor for major cardiovascular events and cardiovascular mortality. But unlike LDL cholesterol, Lp(a) levels are not significantly affected by lifestyle choices or statins. Lp(a) is found in atherosclerotic plaques and has proinflammatory, prothrombotic, and proatherogenic effects driving that progression of atherosclerosis. Epidemiological and genetic studies strongly support a causal and continuous association between Lp(a) levels and cardiovascular outcomes. In fact, Lp(a) is a risk factor even at very low levels of LDL cholesterol. Lp(a) is also an independent risk factor for calcific aortic stenosis. So, how common are elevated Lp(a) levels? Well, around 1 in 5 people globally are at high risk of developing atherosclerotic cardiovascular disease due to elevated Lp(a) levels. However, there are differences with regard to Lp(a) levels across different ethnicities. Black individuals are more likely to have elevated Lp(a) than White, Hispanic, or Asian individuals. Importantly, Lp(a) levels are inherited in a predominantly autosomal dominant manner, which means a child of an affected parent with high Lp(a) levels has a 50% chance of being affected him- or herself. So, what levels of Lp(a) drive an increased risk of atherosclerotic cardiovascular disease? Levels of 32-90 nmol/L confer a minor risk. Levels between 90 and 200 nmol/L confer a moderate risk. Levels of 200-400 nmol/L confer a high risk, and levels greater than 400 nmol/L confer a very high risk. Lp(a) levels need to only be measured once in a lifetime, unless a specific treatment is being undertaken to lower levels, which I will discuss shortly. Heart UK, the UK cholesterol charity, published a consensus statement and call to action on Lp(a) during 2019 that included some useful, pragmatic recommendations for all of us working in primary care. Notably, this consensus gave a number of recommendations on when we should consider checking Lp(a) levels. We should consider checking Lp(a) levels in those with a personal or family history of premature atherosclerotic cardiovascular disease, particularly under the age of 60 years. We should consider checking levels in those with a first-degree relative with high Lp(a) levels over 200 nmol/L. We should consider checking levels in those with a history of familial hypercholesterolemia or another genetic dyslipidemia. We should consider checking levels in those with a background of calcific aortic valve stenosis. And we should also consider checking levels in those with a borderline increased 10-year cardiovascular risk of around about 10% to 15%. This is to aid reclassification of these individuals at intermediate risk of atherosclerotic cardiovascular disease and hopefully encourage acceptance of LDL cholesterol-lowering therapies such as statins. So, how do we manage elevated Lp(a) levels? Currently, there are no approved therapies to treat elevated Lp(a) levels. The most effective therapy for high Lp(a) levels is apheresis, which is a blood filtering process like dialysis. This procedure is reserved for the highest risk individuals, as it is very expensive, requires weekly visits to the apheresis center, and is not without harm. However, newer therapies targeting Lp(a) directly are in development, which will transform the management of high-risk individuals. So, what can we do meanwhile in primary care for those with high Lp(a) levels? We need to mitigate overall cardiovascular risk with aggressive lipid management and targeting of all other cardiovascular risk factors. For those with Lp(a) levels greater than 90 nmol/L (moderate risk and above), we should initiate a high-intensity statin and aim for a greater than 50% reduction in non-HDL cholesterol and an LDL cholesterol of less than 1.8 mmol/L liter or non-HDL cholesterol level of less than 2.5 mmol/L. We should also consider referral to a specialist lipid clinic for those with high-risk Lp(a) levels (greater than 200 nmol/L) but manage all cardiovascular risk factors while waiting for them to be seen. Cascade screening and family should also be offered to individuals with a familial or personal history of high Lp(a) levels or an early history of atherosclerotic cardiovascular disease in the family under the age of 60 years. So, a call to action for us all in primary care: Lp(a) is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease that is not significantly affected by lifestyle choices or statins. We should consider checking Lp(a) levels in those with a personal or family history of premature atherosclerotic cardiovascular disease under the age of 60 years, in those with calcific aortic valve stenosis, or in those where an atherosclerotic event has occurred with no obvious underlying risk factors. Finally, I produced a Medscape UK primary care hack or clinical aide-mémoire on lipid management for the primary and secondary prevention of cardiovascular disease for healthcare professionals. I hope you find this resource helpful. Medscape Family Medicine © 2025 WebMD, LLC Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Cite this: What Is Lp(a), and When Should We Check It? - Medscape - Jul 10, 2025.
