Treatment

If the stroke is caused by a blood clot, our team can quickly administer a medication called Tenecteplase (TNK). This medication may rapidly dissolve the clot thus restoring the brain’s blood flow. The national treatment guideline states that this powerful medication should be administered in less than 60 minutes after the patient arrives at the hospital. However, at Holy Cross Health, we routinely administer TNK in under 30 minutes!

Thrombectomy | The definition of thrombectomy is the mechanical removal of a blood vessel blockage. In most cases, this means the removal of a blood clot that is wedged like a cork into the neck of a bottle, thus blocking the normal blood flow in the brain. In a few cases, the blockage is caused by a narrowed blood vessel (atherosclerosis).

The method of thrombectomy is dependent on the type of blockage. In most cases, it is a simple uncorking. Sometimes however the atherosclerotic disease requires a reopening of the narrowed blood vessel by a procedure called angioplasty. We may also place a stent to reopen the collapsed blood vessel.

Today's two most frequently used clot removal methods are stent retrievers and direct aspiration. Stent retrievers work like a corkscrew. They grab hold of the blood clot and painlessly pull it out. The aspiration method works like a vacuum. A direct aspiration catheter generates a strong force that removes the blood clot.

These procedures are minimally invasive and require only a small incision in the groin. A patient, if fully recovered, often goes home in as little as two to three days.

Stenting and/or Angioplasty | Sometimes blood flow in vessels slows due to plaque build-up. Blood vessels in the brain or neck become stiff and less flexible. Eventually, these arteries become occluded and require a procedure to open them again. This procedure, when done in a minimally invasive manner, is called “stenting.”

Angioplasty is a procedure in which we restore the original appearance of the blood vessel lumen. The blood vessel can be compromised because of various problems, most importantly atherosclerotic disease (hardening of the blood vessels). Due to atherosclerotic disease, plaques grow in the wall of the artery. Plaques may contain cholesterol crystals, calcium deposits, and fragments of blood clots. As they get larger, blood vessels eventually become stenotic or occluded.

To treat this situation, we advance a micro balloon from the right groin into the location of narrowing. As this balloon is inflated, the blood vessel also gets expanded and reopened. This only takes a few seconds. After deflation of the balloon, we frequently also use a device called a stent. This is a metal wire mesh that will prop the artery open. Without that stent the artery would soon collapse again. But with the help of the stent, a blood vessel can keep its size and shape nearly indefinitely.

There are certain limitations for using angioplasty and stenting. Depending on the location of the narrowing or the severity of the disease, stenting may not be the appropriate method of treatment. For these cases, we recommend a surgical procedure which is called endarterectomy. Or we may recommend the patient have a Transcarotid Artery Revascularization (TCAR). This is a new technique that makes it possible to perform angioplasty and stenting in cases where previously it was not feasible. Holy Cross Health is one of the few hospitals in Broward County approved to perform this procedure.

Some hemorrhagic strokes (brain bleeds) may be treated by blocking the bleeding artery from the inside. This procedure is called embolization. Depending on the type of bleeding, such embolization can be done with liquid embolization material (ONYX) or platinum micro coils. A microcatheter is threaded through an artery in the groin and advanced to the source of bleeding. The embolization material is then injected, or deployed, to stop the bleeding. The procedure is minimally invasive and painless. It does not require a surgical approach, shaving of the hair, or drilling into the patient’s skull. Everything is performed from just a quarter of an inch size incision of the skin at the right groin.