Stroke

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Stroke

Topic Overview

What is a stroke?

A stroke occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.

Brain damage can begin within minutes, so it is important to know the symptoms of stroke and act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.

What are the symptoms?

Symptoms of a stroke happen quickly. A stroke may cause:

  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.

If you have any of these symptoms, call 911 or other emergency services right away.

See your doctor if you have symptoms that seem like a stroke, even if they go away quickly. You may have had a transient ischemic attack (TIA), sometimes called a mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early treatment for a TIA can help prevent a stroke.

What causes a stroke?

There are two types of stroke:

  • An ischemic stroke develops when a blood clot blocks a blood vessel in the brain. The clot may form in the blood vessel or travel from somewhere else in the blood system. About 8 out of 10 strokes are ischemic (say “iss-KEE-mick”) strokes. They are the most common type of stroke in older adults.
  • A hemorrhagic stroke develops when an artery in the brain leaks or bursts. This causes bleeding inside the brain or near the surface of the brain. Hemorrhagic (say “heh-muh-RAH-jick”) strokes are less common but more deadly than ischemic strokes.

How is a stroke diagnosed?

You need to see a doctor right away. If a stroke is diagnosed quickly—right after symptoms start—doctors may be able to use medicines that can help you recover better.

The first thing the doctor needs to find out is what kind of stroke it is: ischemic or hemorrhagic. This is important because the medicine given to treat a stroke caused by a blood clot could be deadly if used for a stroke caused by bleeding in the brain.

To find out what kind of stroke it is, the doctor will do a type of X-ray called a CT scan of the brain, which can show if there is bleeding. The doctor may order other tests to find the location of the clot or bleeding, check for the amount of brain damage, and check for other conditions that can cause symptoms similar to a stroke.

How is it treated?

For an ischemic stroke, treatment focuses on restoring blood flow to the brain. If you get to the hospital right away after symptoms begin, doctors may use a medicine that dissolves blood clots. Research shows that this medicine can improve recovery from a stroke, especially if given within 90 minutes of the first symptoms.1 Other medicines may be given to prevent blood clots and control symptoms.

A hemorrhagic stroke can be hard to treat. Doctors may do surgery or other treatments to stop bleeding or reduce pressure on the brain. Medicines may be used to control blood pressure, brain swelling, and other problems.

After your condition is stable, treatment shifts to preventing other problems and future strokes. You may need to take a number of medicines to control conditions that put you at risk for stroke, such as high blood pressure, high cholesterol, and diabetes. Some people need to have a surgery to remove plaque buildup from the blood vessels that supply the brain (carotid arteries).

The best way to get better after a stroke is to start stroke rehab. The goal of stroke rehab is to help you regain skills you lost or to make the most of your remaining abilities. Stroke rehab can also help you take steps to prevent future strokes. You have the greatest chance of regaining abilities during the first few months after a stroke. So it is important to start rehab soon after a stroke and do a little every day.

Can you prevent a stroke?

After you have had a stroke, you are at risk for having another one. You can make some important lifestyle changes that can reduce your risk of stroke and improve your overall health.

Treat any health problems you have

  • Manage high blood pressure or high cholesterol by working with your doctor.
  • Manage diabetes. Keep your blood sugar levels within a target range.
  • If your doctor recommends you take ASA or a blood thinner, take it. This can help prevent having a stroke.
  • Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.

Adopt a healthy lifestyle

  • Do not smoke or allow others to smoke around you.
  • Limit how much alcohol you drink.
  • Stay at a healthy weight. Being overweight makes it more likely you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.
  • Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
  • Eat a balanced diet that is low in cholesterol, saturated fats, and salt. These foods can make hardening of the arteries worse. Eat more fruits and vegetables. Eat fish at least once a month.

Frequently Asked Questions

Learning about stroke:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with stroke:

End-of-life issues:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Stroke: Should I Have Carotid Endarterectomy?
  Stroke: Should I move my loved one into long-term care?

Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
  Heart Disease: Eating a Heart-Healthy Diet
  Stroke recovery: Coping with eating problems
  Warfarin: Taking your medicine safely

Cause

Causes of ischemic stroke

An ischemic stroke is caused by a blood clot that blocks blood flow to the brain. A blood clot can develop in a narrowed artery that supplies the brain or can travel from the heart (or elsewhere in the body) to an artery that supplies the brain.

Blood clots are usually the result of other problems in the body that affect the normal flow of blood, such as:

Low blood pressure (hypotension) may also cause an ischemic stroke, although less commonly. Low blood pressure results in reduced blood flow to the brain and may develop as a result of narrowed or diseased arteries, a heart attack, a large loss of blood, or a severe infection.

Some surgeries (such as endarterectomy) or other procedures (such as carotid artery stenting) that are used to treat narrowed carotid arteries may cause a blood clot to break loose, resulting in a stroke.

Causes of hemorrhagic stroke

A hemorrhagic stroke is caused by bleeding inside the brain (called intracerebral hemorrhage) or bleeding in the space around the brain (called subarachnoid hemorrhage). Bleeding inside the brain may be a result of long-standing high blood pressure. Bleeding in the space around the brain may be caused by a ruptured aneurysm or uncontrolled high blood pressure.

Other causes of hemorrhagic stroke are less common but include:

  • Inflammation in the blood vessels, which may develop from conditions such as syphilis, Lyme disease, vasculitis, or tuberculosis.
  • Blood-clotting disorders, such as hemophilia.
  • Head or neck injuries that result in damage to blood vessels in the head or neck.
  • Radiation treatment for cancer in the neck or brain.
  • Cerebral amyloid angiopathy (a degenerative blood vessel disorder).

Symptoms

If you have symptoms of a stroke, call 911 or other emergency services right away. General symptoms of a stroke include:

  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.

Symptoms can vary depending on whether the stroke is caused by a blood clot (ischemic stroke) or bleeding (hemorrhagic stroke), where the stroke occurs in the brain, and how bad it is.

A stroke usually happens suddenly but may occur over hours. For example, you may have mild weakness at first. Over time, you may not be able to move the arm and leg on one side of your body.

If several smaller strokes occur over time, you may have a more gradual change in walking, balance, thinking, or behaviour (multi-infarct dementia).

It is not always easy for people to recognize symptoms of a small stroke. They may mistakenly think the symptoms can be attributed to aging, or the symptoms may be confused with those of other conditions that cause similar symptoms.

What Happens

When you have an ischemic stroke, the oxygen-rich blood supply to part of your brain is reduced. With a hemorrhagic stroke, there is bleeding in the brain.

  • After about 4 minutes without blood and oxygen, brain cells become damaged and may die.
  • The body tries to restore blood and oxygen to the cells by enlarging other blood vessels (arteries) near the area.
  • If blood supply is not restored, permanent brain damage usually occurs.

When brain cells are damaged or die, the body parts controlled by those cells cannot function. The loss of function may be mild or severe and temporary or permanent. This depends on where and how much of the brain is damaged and how fast the blood supply can be returned to the affected cells.

If you have symptoms of a stroke, call 911 or other emergency services right away. Life-threatening complications may occur after a stroke. Early treatment may decrease the amount of permanent damage to brain cells, decreasing the amount of disability.

Stroke is the most common nervous-system–related cause of physical disability. Of people who survive a stroke, half will still have some disability 6 months after the stroke.

Recovery depends on the location and amount of brain damage caused by the stroke, the ability of other healthy areas of the brain to take over functioning for the damaged areas, and rehabilitation. In general, the less damage there is to the brain tissue, the less disability results and the greater the chances of a successful recovery.

You have the greatest chance of regaining your abilities during the first few months after a stroke. Regaining some abilities, such as speech, comes slowly, if at all. About half of all people who have a stroke will have some long-term problems with talking, understanding, and decision-making. They also may have changes in behaviour that affect their relationships with family and friends.

Long-term complications of a stroke, such as depression and pneumonia, may develop right away or months to years after a stroke. Some long-term complications may be prevented with proper home treatment and medical follow-up. For more information, see the Home Treatment section of this topic.

What to expect after a stroke

In addition to the more obvious physical problems you have after a stroke, you (or a caregiver) may also notice:

If you have concerns, discuss them with your doctor. Your doctor will provide support and may offer other suggestions for dealing with these issues.

What Increases Your Risk

Risk factors for stroke include those you can treat or change and those you can't change.

Risk factors you can treat or change:

  • High blood pressure (hypertension).
  • Atrial fibrillation.
  • Diabetes.
  • Smoking.
  • High cholesterol.
  • Heavy use of alcohol.
  • Being overweight.
  • Physical inactivity.

Risk factors you cannot change include:

  • Age. The risk of stroke increases with age.
  • Race. First Nations and people of African descent have a higher risk than those of other races.
  • Gender. Stroke is more common in men than women until age 75, when more women than men have strokes. Because women live longer than men, more women have strokes each year.
  • Family history. The risk for stroke is greater if a parent, brother, or sister has had a stroke or transient ischemic attack (TIA).
  • History of stroke or TIA.

When To Call a Doctor

Call 911 or other emergency services immediately if you have signs of a stroke:

  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.

Signs of a transient ischemic attack are similar to signs of a stroke. But TIA symptoms usually disappear after 10 to 20 minutes. There is no way to tell whether the symptoms are caused by a stroke or by TIA, so emergency medical care is needed for both conditions.

Call your doctor immediately if you have:

  • Had recent symptoms of a TIA or stroke, even if the symptoms have disappeared.
  • Had a TIA or stroke and are taking ASA or other medicines that prevent blood clotting and you notice any signs of bleeding.
  • Had a stroke and have a choking episode from food going down your windpipe.
  • Had a stroke and have signs of a blood clot in a deep blood vessel, which include redness, warmth, and pain in a specific area of your arm or leg.

Call your doctor for an appointment if you:

  • Think you have had a TIA in the past and have not talked with your doctor about it.
  • Have had a stroke and have a pressure sore.
  • Have had a stroke and notice that your affected arm or leg is becoming increasingly stiff or you are not able to straighten it (spasticity).
  • Have had a stroke and notice signs of a urinary tract infection. Signs may include fever, pain with urination, blood in urine, and low back (flank) pain.
  • Have had a stroke and you are having trouble keeping your balance.

Watchful Waiting

Watchful waiting is not appropriate if you have signs of a stroke. Emergency medical care is needed to prevent or treat any complications that may be life-threatening. Prompt treatment may prevent extensive damage to the brain, reducing permanent disabilities from the stroke.

If the stroke is caused by a blood clot, early care by a doctor in the emergency room or hospital is critical. If you seek help right away, you can sometimes receive a medicine (tissue plasminogen activator, or t-PA) that dissolves clots. This medicine works best when it is given right after symptoms begin. Not everyone can safely receive this medicine.

Who To See

Your family doctor, general practitioner, or an emergency medicine specialist can diagnose and treat stroke.

You may be referred to a specialist, such as a neurologist.

If you need surgery or have other health problems, other specialists may be consulted, such as a:

Some hospitals have a stroke team made up of many different health professionals, such as a physiotherapist, an occupational therapist, a speech therapist, a rehabilitation doctor (physiatrist), a nurse, and a social worker.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

Time is critical when diagnosing a stroke. A quick diagnosis—the sooner, the better—may enable your doctor to use medicines that can lead to a better recovery.

The first priority will be to determine whether you are having an ischemic or hemorrhagic stroke. This distinction is critical because the medicine given for an ischemic stroke (caused by a blood clot) could be life-threatening if the stroke is hemorrhagic (caused by bleeding). Your doctor will also want to rule out other conditions that have symptoms similar to a stroke and to check for complications.

The first test after a stroke is typically a computed tomography (CT) scan of the brain, which is a series of X-rays of your brain that can show whether there is bleeding. This test will help your doctor diagnose whether the stroke is ischemic or hemorrhagic. Magnetic resonance imaging (MRI) may also be done to find out the amount of damage to the brain and help predict recovery.

Other initial tests recommended for ischemic stroke include:

If your doctor suspects or if other tests show narrowing of a carotid artery, he or she may want you to have a carotid ultrasound/Doppler scan to evaluate blood flow through the artery. Your doctor may also request magnetic resonance angiogram (MRA), CT angiogram, or carotid angiogram.

If your doctor believes the stroke may have been caused by a problem with your heart, an echocardiogram or Holter monitoring or telemetry test may be done.

Guidelines recommend that risk factors for heart disease also be assessed after a stroke to prevent disability or death from a future heart problem. This is because many people who have had a stroke also have coronary artery disease.

Treatment Overview

Initial treatment for a stroke happens in the hospital. The sooner you get treatment, the better. The worst damage from a stroke often occurs within the first few hours. The faster you receive treatment, the less damage will occur.

In the hospital

Your treatment will depend on whether the stroke is caused by a blood clot (ischemic) or by bleeding in the brain (hemorrhagic). Treatment focuses on restoring blood flow for an ischemic stroke or controlling bleeding for a hemorrhagic stroke.

Before starting treatment, your doctor will use a computed tomography (CT) scan or magnetic resonance imaging (MRI) of your head to diagnose the type of stroke you've had. For more information about these and other tests, see Examinations and Tests.

Ischemic stroke

Emergency treatment for an ischemic stroke depends on the location and cause of the clot. Measures will be taken to stabilize your vital signs, including giving you medicines.

  • If your stroke is diagnosed soon enough after the start of symptoms, you may be given a clot-dissolving medicine called tissue plasminogen activator (t-PA), which can increase your chances of survival and recovery.
  • You may also receive ASA or another antiplatelet medicine.

Hemorrhagic stroke

Treatment for hemorrhagic stroke includes efforts to control bleeding, reduce pressure in the brain, and stabilize vital signs, especially blood pressure.

  • You will be closely monitored for signs of increased pressure on the brain, such as restlessness, confusion, difficulty following commands, and headache. Other measures will be taken to keep you from straining from excessive coughing, vomiting, or lifting, or straining to pass stool or change position.
  • If the bleeding is due to a ruptured brain aneurysm, surgery to repair the aneurysm may be done. Repair may include:
    • Using a metal clip to clamp off the aneurysm to prevent renewed bleeding.
    • Inserting a small coil into the aneurysm to block it off (endovascular coil embolization).
  • In some cases, medicines may be given to control blood pressure, brain swelling, blood sugar levels, fever, and seizures.
  • If a large amount of bleeding has occurred and the person is rapidly getting worse, surgery may be needed to remove the blood that has built up inside the brain and to lower pressure inside the head.

Preventing another stroke

After emergency treatment for stroke, and when your condition has stabilized, treatment focuses on preventing another stroke. It will be important to control your risk factors for stroke, such as high blood pressure, atrial fibrillation, high cholesterol, and diabetes. Your doctor will probably want you to take one or more medicines to prevent another stroke. For more information on the medicines you may have to take after a stroke, see Medications.

Changes in lifestyle will also be an important part of your treatment to reduce your risk of having another stroke:

Your doctor may also recommend surgery to remove plaque buildup in the carotid arteries. A procedure called carotid artery stenting (CAS) is another option for some people who have blocked carotid arteries. For more information on surgery to prevent a stroke, see Surgery. For more information on CAS, see Other Treatment.

For more information on preventing a stroke, see Prevention.

Rehabilitation

Starting a rehabilitation (rehab) program as soon as possible after a stroke increases your chances of recovering some of the abilities you lost.

It is not possible to predict precisely how much physical ability you will regain. The more ability you retain immediately after a stroke, the more independent you are likely to be when you are discharged from the hospital. After a stroke:

  • People usually show the greatest progress in being able to walk during the first 6 weeks. Most recovery occurs within the first 3 months. But you may continue to improve slowly over the next few years.
  • Speech, balance, and skills needed for day-to-day living return more slowly and may continue to improve for up to a year.
  • About half of the people who suffer a stroke have problems with coordination, communication, judgment, or behaviour that affect their work and personal relationships.

Your rehab will be based on the physical abilities that were lost, your general health before the stroke, and your ability to participate. Rehab begins with helping you resume activities of daily living, such as eating, bathing, and dressing. For more information, see the topic Stroke Rehabilitation.

What To Think About

After a person has had a stroke, family members can learn ways to provide support and encouragement to their loved one.

If you get worse, your loved one may need to move you to a care facility that can meet your needs, especially if your caregiver has his or her own health problems that make it difficult to properly care for you. It is common for caregivers to neglect their own health when they are caring for a loved one who has had a stroke. If your caregiver's health declines, the risk of injury to you and your caregiver may increase. For more information, see:

Click here to view a Decision Point. Stroke: Should I Move My Loved One Into Long-Term Care?

Prevention

You can help prevent a stroke if you control risk factors and treat other medical conditions that can lead to a stroke.

And if you have already had a stroke or a transient ischemic attack (TIA), you can prevent another stroke in the same way, by controlling risk factors and treating medical conditions that can lead to stroke.

Know your stroke risk

These are some of the common risk factors for stroke:

Treat any health problems you have

  • Manage high blood pressure or high cholesterol by working with your doctor.
  • Manage diabetes. Keep your blood sugar levels within a target range.
  • If your doctor recommends you take ASA or a blood thinner, take it. This can help prevent having a stroke.
  • Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.

Adopt a healthy lifestyle

Home Treatment

After a stroke, home treatment will be an important part of your rehabilitation.

You may need to use assistive devices to help you:

  • Eat. Large-handled silverware can be easier to grab and use if you have a weak hand. If you have trouble swallowing, you may need to change your diet or your doctor may provide you with a feeding tube to use at home.
  • Get dressed. Devices called reachers can help you put on socks or stockings if you have weakness in one arm or hand.
  • Walk. Canes and walkers can be used to help prevent falls.

Tips for a successful recovery

  • Be as involved as possible in your care. Although you may feel like letting a caregiver take charge, the more you can participate, the better. Ask for help in dealing with any disabilities you may have, and try to make people understand your limitations.
  • Recognize and deal with depression. Depression is common in people who have had a stroke, and it can be treated. You may need medicines for depression and pain to help you cope.
  • Participate in a stroke rehabilitation program as soon as possible. After a stroke, a combination of physical, speech, and occupational therapies can help you manage the basics of daily living, such as bathing, dressing, and eating. A team that includes a doctor, a variety of therapists, and nurses will work with you to overcome disabilities, learn new ways to do tasks, and strengthen parts of your body impaired by the stroke. For more information, see the topic Stroke Rehabilitation.

Tips for dealing with the effects of a stroke

  • Managing getting dressed. Getting dressed may be easier if you use stocking/sock spreaders, rings or strings attached to zipper pulls, and button hooks. Talk with an occupational therapist about assistive devices that can help you get dressed.
  • Managing vision problems. After a stroke, some people have problems seeing to one side. For example, people with right-sided paralysis may have difficulty seeing to the right.
  • Managing eating problems. You may not be able to feel food on one or both sides of your mouth. This increases your risk for choking. You may need further tests or an evaluation by a speech therapist.
    Click here to view an Actionset. Stroke Recovery: Coping With Eating Problems
  • Managing bowel and bladder problems. Some people who have a stroke suffer loss of bladder control (urinary incontinence) after the stroke. But this is usually temporary, and it can have many causes, including infection, constipation, and the effects of medicines.

Tips for family members and caregivers

  • Family adjustment and support will be important to your loved one's recovery. Strong support from the family can greatly enhance recovery.
  • Help manage speech and language problems with some simple tips. These problems may involve any or all aspects of language use, such as speaking, reading, writing, and understanding the spoken word. Speaking slowly and directly and listening carefully can help.

For more information on rehabilitation (rehab) at home, see the topic Stroke Rehabilitation.

Although stroke rehab is increasingly successful at prolonging life, a stroke can be a disabling or fatal condition. People who have had a stroke may consider discussing health care and other legal issues that may arise near the end of life. Many people find it helpful and comforting to state their health care choices in writing with an advance care plan while they are still able to make and communicate these decisions. For more information, see the topics Advance Care Planning and Care at the End of Life.

Medications

Your doctor will probably prescribe several medicines after you have had a stroke. Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.

The types of medicines that prevent clotting are:

  • Antiplatelet medicines.
  • Anticoagulant medicines.

Cholesterol-lowering and blood-pressure–lowering medicines are also used to prevent TIAs and strokes.

Antiplatelet medicines

Antiplatelet medicines keep platelets in the blood from sticking together.

  • ASA (for example, Aspirin) is most often used to prevent TIAs and strokes.
  • ASA combined with dipyridamole (Aggrenox) is a safe and effective alternative to ASA.
  • Clopidogrel (Plavix) may be used for people who cannot take ASA.

Anticoagulants

Anticoagulants prevent blood clots from forming and keep existing blood clots from getting bigger. If you have atrial fibrillation, you will probably take an anticoagulant such as warfarin (for example, Coumadin). For more information, see the topic Atrial Fibrillation.

Statins

Statins lower cholesterol and can greatly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.3

Blood pressure medicines

If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:

Other medicines

Medicines used to treat depression and pain may also be prescribed after a stroke.

Surgery

When surgery is being considered after a stroke, your age, prior overall health, and current condition are major factors in the decision.

Surgery for ischemic stroke

If you have significant blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgery, a surgeon removes plaque buildup in the carotid arteries to reduce the risk of transient ischemic attack (TIA) or stroke. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke. Your need to have carotid endarterectomy depends on whether you have had a TIA or stroke and how much your carotid arteries have narrowed.

Click here to view a Decision Point. Stroke: Should I Have Carotid Endarterectomy?

Surgery for hemorrhagic stroke

Surgeries for hemorrhagic stroke include:

  • Surgery to drain or remove blood in or around the brain that was caused by a bleeding blood vessel.
  • A procedure (endovascular coil embolization) to repair a brain aneurysm that is the cause of a hemorrhagic stroke. A small coil is inserted into the aneurysm to block it off and stop or prevent bleeding.
  • Surgery (craniotomy) to repair the aneurysm that caused the hemorrhagic stroke. A small metal clip is placed around the base of the aneurysm to block it off. This stops the bleeding in the brain. Whether this surgery can be done depends on the location of the aneurysm, its size, and your general health.
  • Surgery to remove or block off abnormally formed blood vessels (arteriovenous malformation) that have caused bleeding in the brain.

Other Treatment

Stroke rehabilitation (rehab) is a critical part of a successful recovery. Early rehab, begun as soon as possible after the stroke, helps to reduce dependence on others. Most recovery occurs during the first 3 months after a stroke but may continue slowly over the next few years. For more information, see the topic Stroke Rehabilitation.

Carotid artery stenting (also called carotid angioplasty and stenting) is now being done as an alternative to surgery for preventing transient ischemic attack (TIA) or stroke. In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid arteries in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a wire mesh stent to keep the artery open. Carotid artery stenting is not as common as carotid endarterectomy.

Other Places To Get Help

Organizations

Canadian Cardiovascular Society
222 Queen Street
Suite 1403
Ottawa, ON  K1P 5V9
Phone: 1-877-569-3407 toll-free
(613) 569-3407
Fax: (613) 569-6574
Web Address: www.ccs.ca
 

The Canadian Cardiovascular Society works to advance the cardiovascular health and care of Canadians through leadership, research, and advocacy.


U.S. National Institute of Neurological Disorders and Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD  20824
Phone: 1-800-352-9424
Phone: (301) 496-5751
TDD: (301) 468-5981
Web Address: www.ninds.nih.gov
 

The U.S. National Institute of Neurological Disorders and Stroke (NINDS), a part of the U.S. National Institutes of Health, is the leading U.S. federal government agency supporting research on brain and nervous system disorders. It provides the public with educational materials and information about these disorders.


Canadian Association of Cardiac Rehabilitation
1390 Taylor Avenue
Winnipeg, MB  R3M 3V8
Phone: (204) 488-5854
Fax: (204) 928-7873
Web Address: www.cacr.ca
 

The Canadian Association of Cardiac Rehabilitation (CACR) is a professional organization that promotes research in cardiac disease prevention and rehabilitation. The CACR website includes articles on topics related to cardiac disease.


Family Caregiver Alliance
180 Montgomery Street
Suite 1100
San Francisco, CA  94104
Phone: 1-800-445-8106
(415) 434-3388
Email: info@caregiver.org
Web Address: www.caregiver.org
 

This organization supports and assists people who are providing long-term care at home. It also provides education, research, services, and advocacy.


Heart and Stroke Foundation of Canada
222 Queen Street
Suite 1402
Ottawa, ON  K1P 5V9
Phone: (613) 569-4361
Fax: (613) 569-3278
Web Address: www.heartandstroke.ca
 

The Heart and Stroke Foundation of Canada works to improve the health of Canadians by preventing and reducing disability and death from heart disease and stroke through research, health promotion, and advocacy.


Thrombosis Interest Group of Canada
Web Address: www.tigc.org
 

The Thrombosis Interest Group of Canada is dedicated to furthering education and research in the prevention and treatment of thrombosis. Patient information is available on the Web site.


References

Citations

  1. Adams HP Jr, et al. (2007). Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke, 38(5): 1655–1711.
  2. Lindsay P, et al. (2008). Canadian best practice recommendations for stroke care: Summary. Canadian Medical Association Journal, 179(12, Suppl): S1–S25.
  3. Adams RJ (2008). AHA/ASA science advisory: Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke, 39(5): 1647–1652.

Other Works Consulted

  • Abbott AL (2009). Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis. Stroke, 40(10): e573–e583.
  • Adams RJ, et al. (2003). Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: A scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Circulation, 108(10): 1278–1290.
  • Albers GW, et al. (2008). Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians evidence-based practice guidelines (8th ed.). Chest, 133(6, Suppl): 630S–669S.
  • American Heart Association and American College of Cardiology (2006). AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation, 113(19): 2363–2372. [Erratum in Circulation, 113(22): 847.]
  • Bederson JB, et al. (2009). Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke, 40(3): 994–1025.
  • Brott TG, et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1): 11–23.
  • Ederle J, et al. (2009). Randomized controlled trials comparing endarterectomy and endovascular treatment for carotid artery stenosis: A Cochrane systematic review. Stroke, 40(4): 1373–1380.
  • Goldstein LB, et al. (2010). Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online December 2, 2010 (doi: 10.1161/STR.0b013e3181fcb238).
  • Hirsch J, et al. (2008). Executive summary: American College of Chest Physicians evidence-based clinical practice guidelines (8th ed.). Chest, 133(6): 71S–109S.
  • International Carotid Stenting Study investigators (2010). Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): An interim analysis of a randomized controlled trial. Lancet, 375(9719): 985–997.
  • Latchaw RE, et al. (2003). Guidelines and recommendations for perfusion imaging in cerebral ischemia. Stroke, 34(4): 1084–1104.
  • Morgenstern LB, et al. (2010). Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke, 41(9): 2108–2129.
  • Skinner JS, Cooper A (2009). Secondary prevention of ischaemic cardiac events, search date October 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  • Spence JD, et al. (2010). Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. Archives of Neurology, 67(2): 180–186.
  • U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.
  • U.S. Preventive Services Task Force (2007). Screening for carotid artery stenosis. Available online: http://www.ahrq.gov/clinic/uspstf/uspsacas.htm.
  • Wahlgren N, et al. (2008). Thrombolysis with alteplase 3-4.5 h after acute ischemic stroke (SITS-ISTR): An observational study. Lancet. Published online September 15, 2008 (doi:10.1016/S0140-6736(08)61339-2).

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Andrew Swan, MD, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Last Revised August 24, 2011

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