Medical Treatments
Treatments include medical therapies, advanced surgical techniques and neuroradiology procedures. View information on:
- Stroke Diagnosis & Evaluation
- Diagnostic Studies
- New Pharmaceutical Treatments & Emergency Care
- Drugs for Emergency Care
- Drugs for Prevention of Stroke
Pioneering New Diagnosis & Treatment Options
The Stroke Center is at the forefront of new developments in drug therapy for emergency treatment of stroke and stroke prevention.
The Stanford Stroke Center, one of the first centers of its kind in the United States, is pioneering new approaches to the diagnosis and treatment of stroke, and offers patients significantly improved chances for recovery.
The center brings together scientists and clinicians from a variety of backgrounds who are working to provide improved diagnoses and more effective treatments for victims of stroke.
New medications, advanced surgical techniques, and innovative interventional neuroradiology procedures are among the effective options now available for stroke patients.
Stroke Diagnosis & Evaluation
A stroke occurs when blood vessels carrying oxygen to the brain burst or become blocked, damaging the brain cells' ability to control sensation, movement, or function, and eventually causing the nerve cells to die.
Risk Factors for Stroke
The most important risk factor for stroke is hypertension (high blood pressure), which weakens artery walls and promotes atherosclerosis (thickening of the arterial lining). Atherosclerosis, in turn, narrows the arteries and reduces blood flow.
The ability to pinpoint quickly the precise location of a stroke and determine the extent of damage is critical in making treatment decisions during a stroke emergency. For instance, the physician must be able to quickly determine whether the stroke is ischemic (arising from a blocked blood vessel) or hemorrhagic (bleeding caused by bursting of a blood vessel) before the appropriate therapy can begin.
State-of-the-art Brain Diagnostic Devices
The Stanford Stroke Center is one of the few places in the country that has more than a dozen state-of-the-art brain diagnostic devices available to obtain in-depth information about a patient's status.
These highly sensitive tools are of critical importance in diagnosing abnormalities that place a patient at high risk for stroke, such as a blocked blood vessel or the presence of an aneurysm or AVM.
Diagnostic Studies
To obtain complete diagnostic information, several (but not all) of the following diagnostic studies may be performed during an evaluation for stroke or stroke risk.
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Computerized Tomography (CT) Scan
This is generally the first diagnostic test done after a patient with a suspected stroke arrives in the emergency room. It is used to quickly distinguish between ischemic and hemorrhagic strokes. The test involves the use of low-dose X-rays to visualize the brain.
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Magnetic Resonance Imaging (MRI)
MRI is an advanced diagnostic tool that provides a high level of anatomic detail for precisely locating the stroke and determining the extent of damage. Due to its high level of sensitivity, MRI is especially useful when the stroke involves small blood vessels.
The technology involves use of a strong magnetic field, and is performed in a special room free of metallic equipment. Recently, there have been great advances in the early detection of stroke using diffusion (DWI) and perfusion (PWI) weighted imaging. These methods allow early and more accurate detection of acute stroke, improving our ability to treat patients with cerebrovascular problems. Stanford has been a leader in the development of this technique.
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Magnetic Resonance Angiography (MRA)
MRA is a noninvasive technology for imaging the cerebral blood vessels, and yields valuable information regarding blood supply to the brain. The use of intravenous contrast agents has provided great improvements in accurately viewing the cerebral blood vessels. Many such techniques have been pioneered by researchers at Stanford.
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Transcranial Doppler (TCD)
TCD a new, noninvasive ultrasound procedure that allows the assessment of blood flow through the cerebral vessels via a small probe placed against the skull. TCD is a portable test that can be performed frequently at the patient's bedside to follow the progress of medical treatment for stroke.
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Xenon CT Scanning
This is another new noninvasive imaging method that uses the inhalation of the inert gas xenon to measure blood flow in various brain regions.
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Carotid Duplex Scanning
This is a noninvasive study to diagnose blockage in the carotid arteries. This technology involves recording sound waves that reflect the velocity of blood flow.
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Radionuclide SPECT Scanning
This provides data on relative blood flow using the radionuclide Technetium99.
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Positron Emission Tomography (PET) Scanning
A PET Scan measures brain cell metabolism, can determine if brain tissue is functioning even if blood flow to that area appears to be diminished.
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Cerebral Angiography (angiogram)
This method requires injection of a contrast dye through a major artery (usually the femoral artery in the thigh) for evaluation of blood flow to the brain. This procedure is completed in Stanford's Cath/Angio lab. The procedure time is approximately two to three hours; bed rest for six hours is required after the procedure.
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Transesophageal Echocardiography
This involves placing a flexible tube in the esophagus (tube to stomach) to directly image the heart.
New Pharmaceutical Treatments & Emergency Care
Stanford neurologists, neurosurgeons, and radiologists are collaborating on studies to develop and evaluate effective medications for stroke prevention and emergency treatment. Drug therapy is a relatively recent approach to the treatment of stroke, and such research is based on the belief that drugs can minimize stroke damage.
The Stanford Stroke Center is participating in FDA-approved clinical trials of a number of promising pharmaceuticals.
Drugs for Emergency Care
Much of the damage caused by a thrombotic or embolic stroke occurs in the first few hours after the event. Research has focused primarily on the development of new clot-dissolving drugs and medications (neuroprotective agents) that make the brain more resistant to stroke.
Medications that dissolve clots are known as thrombolytic agents. Experimental data and pilot clinical studies suggest that if given within the first few hours after stroke onset, these drugs may dramatically minimize stroke damage.
Following is a brief description of these and two other promising therapeutic approaches:
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Thrombolytic Agents
Tissue plasminogen activator [tPA], widely used to dissolve clots that cause heart attacks, is now being used to dissolve artery-blocking clots in the brain during the critical early stages of stroke. Administration of tPA early after a stroke reduces neurological damage significantly. The drug is most effective when administered within the first three hours of stroke onset but is being tested at Stanford for selected patients up to six hours after stroke onset.
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Neuroprotective Agents
Medications that make the brain less susceptible to the damaging effects of a stroke are called neuroprotective agents. Several of these new drugs are being evaluated in clinical trials at Stanford.
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Hypothermia
In experimental models, cooling of the body is one of the most effective therapies for stroke. Stanford is involved in clinical trials of acute hypothermia.
It is not yet known which stroke patients are the best candidates for these neuroprotective drugs or whether the drugs will be consistently effective.
The medications are investigational and authorized by the FDA for use only in randomized clinical trials; as a result, not every eligible emergency stroke patient will be able to receive them.
Drugs for Prevention of Stroke
Researchers at the Stanford Stroke Center are evaluating a number of medications that help prevent stroke in high-risk patients, particularly those who have had a previous transient ischemic attach (TIA) or minor stroke.
These drugs fall into two major categories: anticoagulants (such as heparin and warfarin) and antiplatelet agents (such as aspirin and ticlopidine).
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Anticoagulants
may be given orally or intravenously. These drugs work by thinning the blood and preventing clotting. They are also used for deep vein thromboses and pulmonary emboli.
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Antiplatelet agents
work by preventing or reducing the occurrence in the bloodstream of a phenomenon known as platelet aggregation. When there is damage or injury to a blood vessel, platelets (one type of blood particle) migrate to the scene to initiate a healing process. Large numbers of platelets clump together (aggregate) and form what is essentially a plug.
This aggregation can sometimes result in formation of a thrombus (blood clot) that may block the artery or break loose and block a smaller artery. By preventing this, antiplatelet agents can reduce the risk of stroke in patients who have had TIAs or prior ischemic strokes. Antiplatelet studies are underway at Stanford to determine the most effective ways to administer these agents.
A number of other drug therapies are also under investigation at Stanford. The development of effective preventive medications will continue to be a major goal of the Stanford Stroke Center.