From the Guidelines
The treatment for a cerebrovascular accident (CVA) or stroke is primarily focused on rapid reperfusion, with intravenous thrombolysis using tissue plasminogen activator (tPA) being the standard treatment for acute ischemic stroke in patients presenting with symptoms up to 4.5 hours after onset.
Treatment Options
- Intravenous thrombolysis: using tPA, which is strongly recommended for treatment of carefully selected patients who can receive the medication within 3-4.5 hours of onset of stroke 1.
- Mechanical thrombectomy: recommended in addition to intravenous thrombolysis to treat patients with demonstrable proximal artery occlusions in the anterior circulation who can be treated within 24 hours of symptom onset 1.
- Endovascular treatment: including catheter-based reperfusion, may confer benefit in carefully selected patients with acute ischemic stroke who are not eligible for intravenous tPA thrombolysis or who have failed to respond to it 1.
Key Considerations
- Time is critical: the prognosis of stroke is very time-dependent, and every minute delay in treating an ischemic stroke can result in significant brain cell death 1.
- Patient selection: careful selection of patients for treatment is crucial, with consideration of factors such as time of symptom onset, stroke severity, and presence of contraindications to thrombolysis 1.
- Imaging-based strategies: the use of imaging-based strategies, such as magnetic resonance imaging diffusion and fluid-attenuated inversion recovery mismatch, can help identify patients who are eligible for intravenous thrombolytic therapy when time of symptom onset is unknown 1.
From the Research
Treatment Options for Cerebrovascular Accident (CVA) or Stroke
The treatment for CVA or stroke primarily focuses on restoring blood flow to the brain and treating stroke-induced neurological damage 2. The following are some of the treatment options:
- Intravenous tissue plasminogen activator (tPA) within 3 hours of stroke onset 3, 4
- Aspirin within 48 hours of stroke onset 3
- Decompressive surgery for supratentorial malignant hemispheric cerebral infarction 3
- Intra-arterial thrombectomy in ischemic stroke, with therapeutic windows extending up to 6 hours or even 24 hours 5
- Surgical interventions for clot evacuation in large intracranial hemorrhage 5
- Management in a stroke care unit, which provides a framework for further study and treatment 3
Secondary Prevention Strategies
Secondary prevention strategies for stroke include:
- Warfarin for patients with atrial fibrillation 3
- Endarterectomy for symptomatic carotid stenosis 3
- Antiplatelet agents 3
- Cholesterol reduction 3
Emerging Therapies
Emerging therapies for stroke treatment include:
- Gamma-aminobutyric receptor agonists (GABA) 6
- Glutamate Receptor inhibitors 6
- Sodium and Calcium channel blockers 6
- Fibrinogen-depleting agents 6
- DM199, a recombinant form of human tissue kallikrein-1 (KLK1) 6
- Cell-based therapies like Neural Stem Cells, Hematopoietic stem cells (HSCs), and Human umbilical cord blood-derived mesenchymal stem cells (HUCB-MSCs) 6