Drug therapy Drug therapy is a stroke treatment that has been developed only in the last decade or so. Previously, stroke could only be treated conservatively to prevent further development of the infarct focus. A great deal of effort and research has been done to find effective drugs that can minimize stroke damage. Nowadays, it is possible to reduce the infarct foci or protect brain cells from ischemic damage by pharmacological treatment. Emergency treatment of stroke Thrombotic stroke or embolic stroke is capable of causing very significant damage within the first few hours. Therefore, the efforts of researchers have focused on developing drugs that dissolve blood clots (thrombolytics) and those that make brain tissue more resistant to stroke (neuroprotective agents). We call drugs that dissolve blood clots thrombolytic drugs, and trial data and clinical studies have demonstrated that thrombolytic agents, when applied appropriately within the first few hours of stroke onset, can reduce stroke injury very significantly. Thrombolytic agents: The most commonly used thrombolytic agent is tissue-type fibrinogen activator (tPA), which can significantly reduce neurological damage by dissolving blood clots, restoring blood flow to blocked blood vessels, and restoring blood supply to damaged brain tissue. It is most effective when applied within the first 3 hours of stroke onset. Recently, a clinical study has suggested that the treatment window for thrombolysis can be extended to 6 hours, and the results of this study could make thrombolysis available to a greater number of patients. However, the current FDA-approved treatment window is still 3 hours. Neuroprotective agents: Drugs that make brain tissue insensitive to the damage caused by stroke are called neuroprotective agents. In animal studies, many drugs have been shown to have neuroprotective effects and to be effective in reducing brain damage after stroke. Several clinical studies are also underway; for example, cytidylcholine has direct neuroprotective and cellular repair effects. Hypothermia: Lowering body temperature is an effective treatment for stroke in animal models, and many clinical studies are ongoing. However, we do not yet know which stroke patients are the best candidates for neuroprotective agent therapy or whether these drugs are always effective. There is currently no confirmed FDA approval for neuroprotective agents, and only in those clinical studies where they can be applied. Carotid endarterectomy: Carotid endarterectomy is a surgical procedure to treat or prevent carotid artery blockage by removing atherosclerotic plaque from the carotid artery wall. Carotid endarterectomy has been shown to be of great benefit in stroke prevention in patients who have had previous minor strokes or TIAs. In some patients with previously asymptomatic carotid artery obstruction, this technique can also prevent strokes. Stereotactic radiosurgery for AVMs Stereotactic radiosurgery is a minimally invasive, low-risk technique that uses the same approach as stereotactic microsurgery to determine the precise location of the AVM. Once located, a beam of radiation is focused on the AVM and irradiated, causing thrombosis within the AVM to occlude the AVM, which then gradually disappears. Because of the precision of this technique, normal brain tissue is not usually affected. This technique can be performed on an outpatient basis and does not require hospitalization. Interventional treatment In addition to newer drug and surgical techniques, interventional techniques are available for selected patients with high-risk AVMs, aneurysms, and arterial blockages. This is a surgical procedure that is performed endovascularly. Endovascular treatment of aneurysms Endovascular treatment of aneurysms is a new interventional technique that can be extremely beneficial for patients who are severely ill and cannot tolerate the trauma of surgery. It is performed by inserting a catheter through the femoral artery to the site of the aneurysm, releasing one or several metal coils inside the aneurysm, which then forms a blood clot to block the aneurysm, thereby preventing subsequent hemorrhagic stroke. Endovascular treatment of AVMs is performed by instilling a “glue”-like substance into the AVM through a tiny catheter, which can reduce the size of the AVM and allow for subsequent microsurgery or radiation therapy. In some patients with AVMs, endovascular treatment alone can completely block and cure the AVM. Cervical and intracranial angioplasty and stenting is also a new endovascular treatment technique. Cerebral angioplasty is similar to angioplasty, which is already widely used in cardiology, in that it allows the partially blocked neck vessels (carotid and vertebral arteries) and intracranial vessels to become more patent, and then the vessels can be kept patent by implanting a tubular metal mesh stent that fits the internal diameter of the vessel.