Stroke Treatment

Ischemic Stroke: Emergency Response

When ischemic strokes occur, our stroke physicians respond rapidly and accurately with medicines and endovascular procedures. Learn About Our Stroke Outcomes and Awards

Tissue Plasminogen Activator (tPA)

Tissue plasminogen activator (tPA) is the most common emergency treatment for stroke. It dissolves arterial blood clots that block the flow of nutrients to the brain.

This lifesaving medication is delivered intravenously to ischemic stroke patients within 4.5 hours of a stroke. With tPA, timing is critical. At UC San Diego Health, we have a track record of administering tPA faster than the average.

Mechanical Thrombectomy/EVT

If there is a medical reason to avoid tPA, our neurovascular surgeons perform mechanical thrombectomy. This minimally invasive procedure removes the clot.

Endovascular thrombectomy (EVT) can be performed up to 8 hours after a stroke. This is done to open blood vessels via a catheter. We have access to the most advanced devices to remove blood clots. Our neurosurgeons train physicians nationwide in the use of this specialized equipment.

Ischemic Stroke: Treating the Cause

Carotid artery stenosis is the narrowing of the two large blood vessels in the neck that supply blood to the brain. The narrowing is usually caused by cholesterol buildup. This condition accounts for about 25% of ischemic strokes.

Our neurosurgeons treat carotid artery stenosis through:

• Carotid endarterectomy (CEA): This is the surgical removal of plaque in the artery.
• Carotid artery stenting (CAS): This procedure involves placing a stent in the carotid artery using catheters to prevent narrowing. This is a minimally invasive procedure.

Read About Carotid Artery Disease and Treatments

Intracranial atherosclerotic disease (ICAD) refers to the narrowing of the arteries in the brain. About 10% of strokes occur due to ICAD. 

Our neurologists work closely with our endovascular neurosurgeons to provide aggressive medical management of this condition. When necessary, we perform balloon angioplasty (widening of the arteries) or intracranial stenting.

Cardiogenic causes, including abnormal heart rhythm (arrhythmia) and patent foramen ovale (PFO), account for about 20% of strokes. 

Our neurosurgeons, neurologists and cardiologists work with a multidisciplinary team to treat cardiogenic conditions, such as surgically correcting PFO to prevent stroke. Learn about our Electrophysiology Program.

Hematologic causes, including bleeding disorders, are treated by the combined expertise of neurosurgeons, neurologists and hematologists to medically manage hematologic disorders associated with ischemic stroke.

Hemorrhagic Stroke: Treatment for a Brain Bleed

Our team provides advanced open cranial and minimally invasive neurovascular treatment for conditions causing a hemorrhagic stroke – saving lives day after day.

Two types of conditions can cause hemorrhagic stroke: vascular lesions, and other medical problems such as high blood pressure. 
Vascular lesions that can cause strokes include:

• Cerebral aneurysms
• Arteriovenous malformations (AVM)
• Dural arteriovenous fistulas (AVF)
• Cavernous malformations (cavernoma)

Cerebral Aneurysm

A brain (cerebral) aneurysm is a weak bulging spot on the wall of a brain artery. We provide advanced minimally invasive catheter-based (endovascular) methods of treatment. This includes flow diversion (pipeline) and endovascular coiling. We also perform cranial surgery for clipping aneurysms and EC-IC bypass.

Learn More About Our Treatment for Brain Aneurysms

Arteriovenous Malformations (AVM)

Arteriovenous malformations (AVMs) are abnormal connections between the arteries and veins in the brain that usually form before birth. AVMs can damage the brain (or spinal cord) by reducing the amount of oxygen reaching neurological tissues. This causes bleeding (hemorrhage) into surrounding tissue by putting pressure on the brain or spinal cord.

Learn More About Our AVM Treatment

Cavernous Malformations (Cavernomas)

Cavernomas are benign vascular lesions that can bleed or cause seizures. Cavernomas are formed from groups of tightly packed, thin-walled, small blood vessels that are filled with slow-moving or clotted blood.

Our neurosurgical specialists may diagnose and precisely remove these lesions with state-of-the-art imaging guidance and physiologic neuromonitoring.

Hemorrhagic Stroke: Treating The Causes

The most common causes of hemorrhagic stroke are underlying medical conditions that can be treated with medication. These include:

• High blood pressure
• Cerebral amyloid angiopathy (CAA): A neurological condition in which proteins called amyloid build up on the walls of the arteries in the brain.
• Conditions that are treated with medications that can cause excessive bleeding, such as aspirin or warfarin.