The strategy and time limits for stroke treatment—whether for Ischemic Stroke, Intracerebral Hemorrhage, or Subarachnoid Hemorrhage—differ completely, and these differences determine the patient’s survival and functional prognosis. Recent advances in treatment have been remarkable; especially for Ischemic Stroke, the advent of thrombectomy has significantly increased cases where residual deficits are drastically reduced.
Treatment Differences Across the Three Types of Stroke
| Feature | Ischemic Stroke (Cerebral Infarction) | Intracerebral Hemorrhage | Subarachnoid Hemorrhage (SAH) |
| Top Priority Goal for Survival | Reopen the blocked vessel as quickly as possible. | Stop the bleeding + Lower intracranial pressure. | Absolutely prevent re-bleeding. |
| Golden Time | Within 4.5 hours (t-PA) ∼8–24 hours (Thrombectomy). | As soon as possible (Ideally within a few hours). | Within 72 hours (No later than 1 week). |
| Main Hyper-Acute Treatment | ① t-PA intravenous injection (within 4.5h) ② Thrombectomy (direct clot retrieval by catheter). | Aggressively lower blood pressure (to ≈140–160 mmHg). | Open surgery (Clipping) or Coil Embolization. |
| Timing of Surgery | Thrombectomy is within 6–24 hours. | Only when the hematoma is large and compressing the brain. | As soon as possible (Ideally within 48–72 hours). |
| Name of Surgery | Mechanical Thrombectomy | Hematoma Removal / Ventricular Drainage | ① Open Clipping ② Coil Embolization |
| Surgical Rate | Only ≈10–15% (for large vessel occlusion). | ≈20–30%. | Almost 100%(sometimes done for unruptured aneurysms). |
| Biggest Enemy During Hospitalization | Re-occlusion / Brain Edema | Re-bleeding / Hydrocephalus | Vasospasm (Peaking 4–14 days post-onset). |
| Main Post-Discharge Meds | ① Antiplatelet drugs (Aspirin, Clopidogrel) ② Anticoagulants (Warfarin/DOACs) if Atrial Fibrillation. | Blood pressure medication (must be taken continuously!). | Almost no medication (Nifedipine, etc., is temporary). |
| Most Important for Recurrence Prevention | Depends on the cause (AF → Anticoagulants; Atherosclerosis → Statins + Antiplatelets). | Keep blood pressure below 140/90 mmHg. | Recurrence is almost zero if surgery is successful. |
| Treatment Advancement (Last 10 Years) | Highly advanced! (Thrombectomy drastically reduced sequelae). | Relatively unchanged (BP management is key to survival). | Coiling increased, open clipping decreased. |
| Survival Rate (Current as of 2025) | Over 90% if treated in the hyper-acute phase. | Approx. 50–70%. | Approx. 60–70%(Much better than in the past). |
Summary
- Ischemic Stroke → “Open the blockage immediately!” (A race against time).
- Intracerebral Hemorrhage → “Aggressively lower BP to stop bleeding” (Surgery is for a minority).
- Subarachnoid Hemorrhage → “Surgery to seal the bulge is the lifesaver” (Re-bleeding = almost certain death).
The greatest treatment advancement is in Ischemic Stroke (especially Thrombectomy)! It is now common for people who “would have been bedridden 10 years ago to walk home normally after discharge.”
