When a patient arrives at the urgent care center/emergency room, doctors will conduct an examination (it is best to have a neurologist present as well). If a stroke is suspected, a CT is required. The aim of the CT is to confirm the diagnosis and determine whether the stroke is ischemic or hemorrhagic.

Next, if it is a stroke that causes significant neurological deficiency, and not a minor or fleeting event, suitable treatment will be determined in accordance with how much time has passed since the first appearance of symptoms.

Treatment in the Hours After an Ischemic Stroke

Intravenous treatment with tPA to dissolve a blood clot in the blood vessels that supply the brain

Tissue plasminogen activator (tPA) helps break down blood clots. This treatment may only be administered within the first four and a half hours from the onset of stroke symptoms, and after brain hemorrhage has been ruled out with a CT. The treatment requires hospitalization in the neurological ward and medical supervision. tPA treatment significantly reduces the risk of permanent disability after a stroke. The medication should not be administered outside the above time window, as this can increase the chance of intracranial hemorrhage.

tPA dissolves the blood clot and restores proper blood flow to the site of the occlusion in the brain. It thus provides the most significant reduction of mortality rate and risk of disability as a result of a stroke. 

tPA is included in the health care basket for any stroke patient for whom it is appropriate. The medication is administered only to patients who meet a clear and specific set of criteria. It is available at all medical centers in Israel that operate emergency rooms.

Brain Catheterization

Brain catheterization is treatment in which a large blood vessel in the brain is catheterized in order to extract a blood clot obstructing it. This treatment is called endovascular thrombectomy. The treatment is effective if administered within six to eight hours from the first appearance of ischemic stroke symptoms. Under certain medical conditions this time frame can be extended up to 24 hours. The treatment is provided only at major hospitals that have medical personnel who specialize in it.

In the framework of the treatment, a catheter — a thin tube — is inserted under image guidance into an artery in the groin area and passed upward through the aorta toward the blocked artery in the brain. There are different methods of removing the blood clot from the blood vessel in the brain, and the decision about which method to use varies from case to case. The treatment is sometimes performed under general anesthesia and usually takes one to three hours.

Today, this type of catheterization is administered only to stroke patients with an occlusion in a large blood vessel that supplies the brain, sometimes in conjunction with tPA and sometimes not.

Brain catheterization is performed according to clear and recognized criteria. Sophisticated imaging methods can show whether the brain tissue can be salvaged and whether catheterization can be performed. Catheterization is performed when the chances of rehabilitating brain activity are high.  

Treating Hemorrhagic Stroke

Hemorrhagic stroke accounts for around 10% of all stroke cases and is caused by the rupture of a blood vessel that leads to intracranial bleeding. The treatment of hemorrhagic stroke is complex. In the first stage of treatment, doctors look for the source of the hemorrhage in order to control it.

Unlike in ischemic strokes, there is no unique treatment for an intracranial hemorrhage. So far, no surgery of any kind has been proven effective in minimizing brain damage.  Today the main treatment for hemorrhagic stroke is reducing blood pressure to prevent the spread of bleeding. Sometimes emergency brain surgery is required to reduce pressure that damages the brain tissue.

The mortality rate of intracranial hemorrhage is high.

Hemorrhagic stroke patients who normally take anticoagulants or blood thinners are required to stop using these medications.

In cases where high blood pressure is the cause of the ruptured blood vessel that led to the intracranial hemorrhage, the patient is given medication to lower blood pressure for secondary prevention of the hemorrhage.

Conservative Treatment

When the patient’s arrival at the hospital is delayed and it is too late to administer treatment with tPA or catheterization, or in cases of mini-stroke (transient ischemic attack or TIA), the patient will be given conservative treatment, including medication to regulate blood pressure and antiplatelet medications such as aspirin or clopidogrel (Plavix) to prevent complications and recurrence of the event.