Stroke Treatment Options

Using highly-detailed information derived from the Stroke and Cerebrovascular Center’s advanced diagnostic capabilities, the multidisciplinary team of specialists in the Center works together to deliver the best treatment combination for each patient, including medical, interventional, and surgical therapies.

Medical and Endovascular Therapies

Center specialists often use intravenous and intra-arterial thrombolytic agents in the treatment of stroke. Medical treatment for stroke at the Center includes:

  • Intravenous thrombolysis with tPA
  • Intra-arterial thrombolysis with tPA and mechanical thrombolysis and clot retrieval
  • Identification and treatment of the underlying cause and associated risk factors as secondary prevention

Neurosurgical Procedures

  • Simple and complex intracranial bypass procedures
  • Craniectomy and hemispheric decompression for stroke patients with a large area of brain affected
  • Carotid endarterectomy, skull base approaches to aneurysm clipping, and AVM resection to prevent stroke or stroke recurrence while minimizing disturbance of normal brain tissue
  • Stereotactic radiosurgery to treat AVMs inaccessible by other means
  • Endovascular surgery to treat intracranial aneurysms, AVMs, and extracranial and intracranial obstructions (angioplasty, stenting)

Intraoperative arteriography is used during many surgical procedures to confirm success before closure.

Neuro-interventional Procedures

The state-of-the-art interventional neuroradiology suite at Brigham and Women’s Hospital includes several procedure rooms within the OR complex dedicated to neuro-interventional procedures. The suite’s novel, flat plate angiographic scanner provides lower radiation exposure and highquality, three-dimensional images that guide interventionalists Kai U. Frerichs, MD, and Darren Benjamin Orbach, MD, enabling them to perform advanced therapeutic procedures more easily and safely. These procedures include:

  • Urgent revascularization of acute arterial occlusions
  • Angioplasty and stenting of occlusive vascular lesions in the carotid arteries and intracranial blood vessels and coil embolization of cerebral aneurysms
  • Coiling of intracranial aneurysms, including a new detachable coil that encourages scar tissue formation during aneurysm healing
  • Microcatheter injection to fill malformations and decrease the risk of dangerous bleeding in patients with intracranial vascular malformations, including AVMs.

Neuroscience ICU

Medical Director Galen V. Henderson, MD, and Surgical Director William B. Gormley, MD, lead the dedicated, 20-bed Neuroscience Intensive Care Unit at Brigham and Women’s Hospital. The Neuroscience ICU includes:

  • Neurologists, neurosurgeons, and other specialists working as a team to provide care for patients with acute neurological conditions, such as ischemic stroke, subarachnoid and intracerebral hemorrhage, Guillain-Barré syndrome, myasthenia gravis, status epilepticus, and encephalitis
  • State-of-the-art equipment, including onsite CT imaging and intracranial monitoring
  • New intracranial tissue oxygenation monitors and microdialysis catheters to measure real-time cerebral biochemistry.
  • Highly trained, specialized neuroscience nurses that carefully monitor patient's recovery

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