There are two types of stroke:
Ischemic stroke is the most common and is caused by a lack of blood flow to the brain. It requires emergency treatment and also close follow-up care to prevent another stroke.
Hemorrhagic stroke occurs when a blood vessel bursts inside the brain.
Ischemic Stroke: Emergency Response
Advanced Clot-Removal for Ischemic Stroke
UC San Diego Health is the only medical center in San Diego with stroke specialists in the hospital 24/7 who also provide excellent secondary care.
When ischemic strokes occur, our stroke physicians respond rapidly and accurately with medicines and endovascular procedures.
Tissue Plasminogen Activator (tPA)
Tissue plasminogen activator (tPA) is the most common emergency stroke treatment medication. tPA dissolves arterial blood clots that block nourishment from getting to the brain.
This life-saving 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 faster-than-average administration of TPA.
If there is a medical reason to avoid the use of 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 leading-edge devices to remove blood clots. Our neurosurgeons train physicians throughout the country on the use of this specialized equipment.
Ischemic Stroke: Treating the Cause
Secondary treatment focuses on diagnosing and treating the condition that caused the stroke.
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 the buildup of cholesterol. This condition accounts for about 25 percent of ischemic strokes.
UC San Diego Health neurosurgeons treat carotid artery stenosis through:
Intracranial atherosclerotic disease (ICAD) is the narrowing of arteries in the brain. About 10 percent of strokes occur due to ICAD.
UC San Diego Health 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 approximately 20 percent of strokes.
UC San Diego Health neurosurgeons, neurologists and cardiologists work in 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)
A 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.
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.
Treating Arteriovenous Malformations
We use three treatment approaches for AVMs that may be used in combination, depending on the size and location of an AVM, including:
- An endovascular treatment using catheters to deliver liquid embolic material (glue or Onyx) to the AVM so that blood no longer flows through it.
- Craniotomy to access and resect the AVM from healthy brain tissue. We use precise neuromonitoring and imaging to guide our surgery.
- Stereotactic radiosurgery, which delivers precise, high-intensity radiation to an AVM located deep in the brain tissue. This eventually causes the blood vessels feeding the AVM to close off.
Types of AVMs
Dural Arteriovenous Fistula
A dural arteriovenous fistula (dAVF) or CCF (carotid cavernous fistula) is a form of AVM – an abnormal connection between arteries and veins that occurs in the dura mater of the brain. Dura mater is a protective layer between the brain and skull.
Dural arteriovenous fistulas and venous sinus thrombosis can cause headaches, increased pressure in the brain, seizures and hemorrhages. Diagnosed by cerebral angiography, these complex lesions can be treated with a variety of endovascular methods at UC San Diego Health.
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.