Treatment
If the patient has had an ischemic stroke, meets certain conditions, and the time frame since the stroke has been less than 3 hours, the patient may be a candidate for thrombolytic therapy. New research supports use of rtPA in the 3- to 4.5-hour window, but the relative efficacy of this measure outside the 3-hour window compared with other interventions has not been established. (Rothwell 2009)
Some patients with ischemic stroke who are outside the 3-hour time limit for thrombolytics may be candidates for clot removal with a mechanical embolus remover such as the Merci Retriever or stent-like devices such as the Trevo Retriever or Solitaire device. At this time, the use of stent retriever devices is supported over the use of Merci Retriever. (Broussalis et al 2013; Nogueria et al 2012) Care of patients who suffer a hemorrhagic stroke includes stabilization of blood pressure and magnetic resonance imaging (MRI) or cerebral angiography to locate the site of the aneurysm. A decision is made by the family and patient to either clip or coil the aneurysm. (Go et al 2014)