By Ronnie Musselwhite
“Decades ago, treatment of strokes was ‘Take two aspirin and call me in the morning,’ and then it transitioned into acute treatment where we had options within the first few hours,” said Alexander Schneider, MD, a stroke neurologist and Chief of Neuroscience with Mission Hospital. “Now, we’re able to treat out to six, and in some cases 24, hours in patients who have large strokes. Our advanced neuroimaging techniques allow us to determine who may benefit from these treatments.”
Treatment varies based on the individual and his or her symptoms, as well as the type of stroke he or she experiences.
Ischemic events, which account for roughly 87 percent of all strokes, are most often treated with intravenous tissue plasminogen activator (tPA), a clot-busting drug that improves blood flow to the brain.
Doctors at Mission Hospital, the only comprehensive stroke center in western North Carolina, can also perform clot retrievals (mechanical thrombectomies), a minimally invasive procedure in which a wire stent retriever is threaded through an artery in the groin up to the blocked vessel in the brain. The stent then opens up to engage the clot for extraction. Suction catheters can also be utilized for clot removal. In western North Carolina, these advanced treatment options are only available at Mission Hospital.
With hemorrhagic strokes, the first course of action is to reduce blood pressure and bleeding on the brain. In hemorrhages due to aneurysms, steps are taken to secure it and prevent it from rebleeding. One option is surgical clipping, whereby a neurosurgeon opens the skull and places a small clip across the aneurysm to prevent rebleeding.
Another option is endovascular coiling where an interventional neuroradiologist feeds a catheter through the groin artery to the brain and inserts platinum wires (coils) inside the aneurysm to seal off the aneurysm from the artery. “Coiling is a very effective procedure with much lower risks than open surgery,” said Dr. Schneider. “It’s become the preferred method of aneurysm securing in practice today.”
With newer technologies and approaches, Mission Hospital also offers minimally invasive surgical approaches to the treatment of brain hemorrhages not due to aneurysms.
Transient Ischemic Attack
Transient ischemic attacks (TIAs) differ from the major types of stroke because blood flow to the brain remains blocked for only a short amount of time — usually no more than several minutes or hours. However, these events are early indicators that something is wrong and that a more serious event is likely.
In fact, one-third of people who have a TIA go on to have a more severe stroke within a year. Treatment options for TIA are generally more preventive in nature and may include carotid endarterectomy and carotid stenting, both of which are performed at Mission Hospital.
Spectrum of Care
“The main differentiator at Mission Hospital’s Comprehensive Stroke Center is the technologies and therapies for stroke we have to offer all of WNC. The providers here across the healthcare spectrum are what make us particularly special. From the nurses and therapists to the specialist physicians, our dedicated team maintains high-level neurologic competencies to provide quality, safe, and personalized care. All of this in conjunction with other ancillary services and administrative support allows us to be the premier neuroscience center in western North Carolina.”
–Alexander Schneider, MD, stroke neurologist and Chief of Neuroscience with Mission Hospital
Alexander Schneider, MD, is a stroke neurologist and Chief of Neuroscience with Mission Hospital.