What Are the Treatments for Stroke?

If you get to the hospital outside that 4½-hour window, or if doctors determine you aren’t a good candidate for one of the clot-busting drugs (the main side effect of these meds is bleeding), you may be given a blood-thinning medication to keep blood clots from getting larger or stop new ones from forming.

Depending on your medical history and the size and location of the blood clot, you may qualify for a mechanical thrombectomy, a procedure that involves threading a catheter through an artery in the groin up to the blocked artery to grab the clot and retrieve it. “This procedure can be performed up to 24 hours after symptom onset for patients with blockages in major brain blood vessels,” says Deepak Gulati, M.D., a vascular neurologist who specializes in stroke care at The Ohio State University.

Both treatments have dramatically changed what it means for people who’ve had an ischemic stroke. A 2023 report in the journal Stroke suggests that treatment with a tPA results in a greater chance of positive outcomes compared to supportive medical therapy alone, and that treatment with mechanical thrombectomy results in a 20 to 27 percent improvement in regaining independence following stroke.

“When we give clot-busting medications or pull out a clot in the brain of someone having an ischemic, or clotting, stroke, we’re trying to rapidly restore blood flow to the brain cells and minimize the damage,” says Stein. “We’re trying to prevent the cells at risk of dying from fully dying.”

Treatments for hemorrhagic stroke

A stroke that causes the brain to hemorrhage, or bleed, is more difficult to treat and has a poorer prognosis than an ischemic stroke. About half of adults who experience a hemorrhagic stroke die within weeks. Those who survive may never recover to their prestroke selves.

Treatment is aimed at controlling the bleeding and reducing pressure in the brain caused by the buildup of fluid. How doctors go about doing that depends on the part of the brain that’s bleeding and how much. But as with ischemic stroke, getting treatment as quickly as possible is key to a full recovery. The first 24 to 48 hours following a hemorrhagic stroke are crucial for stabilizing the patient. Blood pressure is aggressively managed to minimize further bleeding, and oxygen levels and heart rate are monitored to prevent further brain damage, says Gulati. “Depending on the severity, treatment may involve medications or, in severe cases, surgery [such as a craniotomy to open the skull] to relieve pressure or repair a ruptured blood vessel.”

The patient’s overall health also plays a role in determining the stroke treatment — no matter which type of stroke . “Conditions such as high blood pressure, diabetes and high cholesterol are major stroke risk factors and can influence treatment options,” Gulati says. Heart diseases, including atrial fibrillation, are factors that can also influence management. “The preexisting use of blood thinners or other medications can complicate treatment, especially in hemorrhagic strokes, where bleeding is a concern,” he adds.

Rehab and recovery from a stroke

Neuroplasticity is the brain’s ability to change and adapt. “This remarkable ability allows healthy brain cells to reorganize and take on functions of the damaged areas, paving the way for recovery,” Gulati says.

That’s where rehab comes in.

“Rehabilitation therapies play a critical role in activating neuroplasticity, helping individuals reclaim lost skills and improve their quality of life,” says Gulati. “Researchers are also investigating innovative approaches, such as neuroprotective drugs and advanced techniques, to promote brain healing. Although these developments are still in progress, they hold promise for transforming stroke recovery in the future. Early treatment and dedicated rehabilitation remain key to overcoming the impact of stroke.”

It may seem separate from treatment, but rehab is as critical to your recovery as any medication or procedure. A review of studies published in 2024 in the Journal of Clinical Medicine shows just how important early rehab is for patients who’ve had the most common type of hemorrhagic stroke — what’s known as an intracerebral stroke, or bleeding within the brain. Not only does early rehab improve the odds of recovery (the 30-day mortality rate for an intracerebral stroke is 34 to 50 percent), but waiting can also raise your risk of permanent disability or death.

No matter the type of stroke, rehab begins in the hospital, often as soon as the next day, and can last for months or years, depending on the severity of the stroke and the area of the brain that’s been affected. “There isn’t a single patient who can’t benefit from rehab,” Stein says. “This is the ultimate interdisciplinary team effort, with physical therapists, occupational therapists, speech therapists and cognitive therapists. The importance of this interdisciplinary team cannot be overstated.”

The multipronged approach includes some combination of:

• Occupational therapy to relearn the activities of daily life, such as dressing, cooking, bathing.
• Speech therapy to help with swallowing and regaining the ability to speak, or developing new ways of communicating if speaking is difficult.
• Psychotherapy to help with depression or anxiety post-stroke.
• Physical therapy to regain strength, balance and walking ability. “I tell my patients that exercise is the only wonder drug we have,” says Stein. In one study, published in 2021 in Cerebrovascular Diseases, stroke survivors who did a mix of aerobic activity, like brisk walking and strength training, had significantly better health outcomes two years after their stroke than the non-exercisers.  

“Intensive rehabilitation — as well as, hopefully in the future, new neuromodulation techniques can help the brain adapt and develop new ways of doing everyday things made difficult by the damage from a stroke,” adds Stein.