Treatment of ischemic stroke

Ischemic stroke is the most common vascular catastrophe of the brain, accounting for 80–85% of all strokes. In my practice, I have repeatedly seen patients who received proper treatment within the first hours and did not abandon rehabilitation — they return to work, hobbies, and communication with loved ones.

Recovery is a marathon, not a sprint. This article will help you understand what the path to regaining lost skills consists of. Do not give up. We are here to help.

What happens during an ischemic stroke

An ischemic stroke occurs when a blood clot or atherosclerotic plaque blocks a cerebral artery. The brain area stops receiving oxygen and nutrients, and neurons begin to die. Unlike a hemorrhagic stroke, where a vessel ruptures and bleeding occurs in the brain, here there is no hemorrhage — there is acute oxygen starvation of the tissues.

The longer the blockage persists, the more extensive the damage zone and the more severe the consequences may be:

• speech impairment;
• limb paralysis;
• loss of sensation;
• dizziness and loss of coordination;
• facial asymmetry.

The "therapeutic window" — the first 4.5 hours from the onset of the first symptoms — is critically important. During this period, thrombolysis can be performed to fully restore blood flow. Within the first 1.5 hours, the chances of complete recovery are maximal.

After 4.5 hours, thrombolysis is not used due to the risk of complications — in such cases, doctors perform mechanical thrombectomy. Remember: every 15 minutes of delay reduces the chance of a good recovery. At the first signs, immediately call an ambulance by dialing 103 or 112.

How ischemic stroke is treated

After a CT or MRI scan confirms the ischemic nature of the stroke, comprehensive therapy begins. The main method is thrombolysis: intravenous administration of a drug that dissolves the clot and restores blood flow. This is the "gold standard" that, when applied promptly, prevents neuronal death.

The drug is administered by drip over the course of an hour under constant blood pressure and pulse monitoring. If a large artery is thrombosed and thrombolysis is impossible or ineffective, mechanical thrombectomy is performed — a minimally invasive operation where the surgeon removes the clot through a catheter. The method is effective for up to 6–24 hours depending on the location of the clot and the patient's condition.

Concurrently, basic therapy is administered:

• blood pressure control with gradual reduction;
• monitoring of glucose levels and body temperature;
• prescription of antiplatelet agents to prevent recurrent thrombosis;
• prevention of deep vein thrombosis using compression stockings and early mobilization.

Rehabilitation at the Neuro Clinic

Rehabilitation begins while still in the hospital, but the main recovery journey continues after discharge. At the Neuro Clinic, the patient receives a full rehabilitation cycle — a comprehensive program tailored individually to each patient.

The process includes several key stages:

• consultation with a neurologist and a physical and rehabilitation medicine physician to assess motor, speech, and cognitive impairments;
• formation of a multidisciplinary team (neurologist, rehabilitation specialist, physical therapist, exercise therapy instructor, speech therapist, occupational therapist, clinical psychologist);
• motor rehabilitation: physical therapy, mechanotherapy, stabiloplatform training, fine motor skills development;
• speech therapy rehabilitation for speech and swallowing disorders;
• occupational therapy and daily living adaptation;
• psychological support to combat depression and find motivation;
• medication therapy in the treatment room and day hospital.

Questions for the doctor: the main points in brief

• Is it possible to fully recover after a stroke? Yes, with a small lesion and timely thrombolysis, full recovery is possible. For extensive lesions, the maximum possible return of functions.
• How does an ischemic stroke differ from a hemorrhagic one? In ischemic stroke, there is a vessel blockage; in hemorrhagic stroke, there is a rupture and bleeding. The treatment is different. Without CT or MRI, they cannot be distinguished.
• Which medications should be taken after discharge? Only those prescribed by your attending physician. Independently replacing or discontinuing medications is life-threatening.
• How long does recovery take? The first 3–6 months are the period of maximum progress. However, improvements are possible even after one or two years. The brain is plastic.