Programs and Services

Advanced Treatments

The Stroke and Neurovascular Program offers the most advanced treatment options available, including many non-invasive interventional treatments to treat and prevent recurrent stroke. Treatments include:

Clot-busting Drugs

Ischemic stroke, which involves a blockage of blood flow to a portion of the brain, can be treated in some patients during the first three hours of an attack, using thrombolytic (clot-busting) drugs such as Tissue Plasminogen Activator (tPA), which destroys harmful blood clots. The Stroke and Neurovascular Program is a leader among hospitals in Wisconsin in administering tPA to stroke patients. See tPA statistics.

Most stroke patients do not arrive within the three-hour timeframe for providing tPA, however. Froedtert & The Medical College perform advanced treatments that extend the time window for treatment — by 8 to 12 hours in some cases.

Hemorrhagic stroke, which involves the bursting of a blood vessel in or near the brain, is treated using different therapies. Many such strokes are the result of an aneurysm (a bulging blood vessel) that has burst. In the past, many of these high-risk aneurysms were inoperable. Advances in neuroradiology at Froedtert & The Medical College of Wisconsin now make treatment possible.

Vascular Neurosurgery

Vascular neurosurgery involves a complete range of treatment options for disorders of brain blood vessels. These include surgery for vessel malformation, aneurysms, carotid stenosis (narrowed carotid arteries) and cerebral insufficiency (decreased blood flow to the brain caused by clogged arteries). Treatments range from minimally invasive to complex surgical procedures.

Gamma Knife® is a neurosurgical tool designed for the treatment of brain disorders. It uses radiation to treat inoperable lesions, and is especially useful for patients who are not suitable for standard surgical techniques. Gamma Knife® enables patients to undergo a non-invasive form of brain surgery without the risk of surgical complications and general anesthesia.

In stroke, Gamma Knife® allows noninvasive surgery of malformations in brain blood vessels. The “blades” of the unit are beams of gamma radiation programmed to target a lesion in the brain. The unit provides highly accurate irradiation of targeted areas, using beams of radiation with scalpel-like precision. The area being treated receives a high dose of radiation with minimum risk to nearby tissue and structures.

Interventional Neurology Procedures to Treat Stroke

In recent years, care for stroke, especially ischemic stroke (caused by a blocked artery), has evolved from supportive care to highly interventional treatments. In the Stroke and Neurovascular Program, interventional neurologists use non-invasive interventional techniques to treat brain aneurysms, open blocked arteries in the brain and remove clots in brain arteries. These procedures are aimed at limiting and possibly reversing stroke injury and preventing recurrent stroke.

Clinical Studies of Stroke Interventions

As an academic medical center, Froedtert & The Medical College have a long-standing commitment to research. Clinical trials provide new ways to find effective treatments and are an important part of care in the Stroke and Neurovascular Program. Clinical stroke trials underway in the Stroke and Neurovascular Program include:

Interventional Management of Stroke (IMS III) Trial — a multi-center study for patients with acute ischemic stroke within three hours of symptom onset
Aortic Balloon catheterization (SENTIS Trial) — a trial investigating the augmentation of cerebral perfusion in patients with acute ischemic stroke who are not eligible for treatment with tPA, using an intra-aortic balloon within eight hours of stroke onset

Other Acute Interventional Stroke Therapies

Merci® Retriever — when IV tPA cannot be used, the Merci® Retriever is an option for some stroke patients. The FDA approved the device in 2004 to remove clots from blocked brain arteries, and it is approved for use up to eight hours after the onset of stroke symptoms. The retriever is guided through a catheter to the brain artery where the clot is lodged. The tip of the retriever has a series of loops, like a corkscrew, which the physician maneuvers to grab the clot and slowly pull it out of the artery. The Merci device can be effective in treating large blood clots — the kind that cause a major and fatal stroke.
Administering tPA Directly into a Clot — this alternative therapy is targeted for patients who arrive more than three and within six hours from the start of stroke symptoms. If a clot is found blocking a large brain artery, a small catheter can be placed within the blockage to deliver tPA directly into the clot and dissolve it, restoring normal blood flow to the brain.

Interventions to Prevent Recurrent Stroke

Wingspan™ stent — approved by the FDA in 2005, the Wingspan stent (a small tube) is designed to treat brain arteries narrowed by atherosclerosis. Patients who have had a stroke caused by narrowed arteries within the brain are at a very high risk of having more strokes. Treatment with the Wingspan stent is a new option for these patients, in addition to treatment with standard medical therapies. Initial clinical trials suggest the Wingspan stent may be particularly effective in lowering the risk of recurrent stroke in patients who have greater than 70 percent blockage of an artery within the brain.
Carotid stenting — patients with carotid artery stenosis (narrowing of the carotid arteries, the arteries that supply the head and neck with oxygenated blood) are at an increased risk of stroke. Carotid artery angioplasty with stenting is a new alternative treatment for patients with carotid stenosis who previously could only be treated with open surgery. Carotid stenting is less invasive, has a shorter recovery time and appears to be safer than surgery for patients with heart disease, lung disease, uncontrolled diabetes, end stage renal disease, advanced age, blockage of the opposite carotid artery, previous carotid surgery, previous neck surgery or prior radiation to the neck.
Intracranial angioplasty — an interventional procedure that uses a balloon-tipped catheter to enlarge a narrowed artery in the brain. Angioplasty may be used to open narrowed brain arteries, preventing strokes in patients for whom standard medication had failed. Angioplasty uses a tiny balloon threaded through a catheter to the blockage in a brain artery. Once in this area, the balloon is inflated. As it expands, it forces the plaque against the artery wall, opening the vessel. In some cases, a stent (a thin wire tube) also is inserted in the artery to keep it propped open.
Guglielmi detachable coils — detachable coil embolization is a non-invasive technique to treat aneurysms (weakness in the artery wall) and other blood vessel malformations in the brain. The coil is used to prevent the flow of blood into the aneurysm sack by filling the aneurysm with coils and blood clots. To perform detachable coil embolization, an interventional neurologist inserts a catheter into an artery in the leg. The catheter is moved through the body to the site of the aneurysm. Then, one or more small coils are placed through the catheter into the aneurysm. The body forms a blood clot around the coil, blocking off the aneurysm.

Last Review Date: Feb. 19, 2010

Online Editor(s): Christopher Sadler