The first-choice treatment for the most common type of stroke (ischemic stroke) is a clot-busting drug called tissue plasminogen activator (tPA, pronounced "T-P-A"). It is usually injected into one of your veins. This drug travels in the blood to your brain and breaks up the clot.

To work properly and safely, tPA should be given within 3 hours (but can be given up to 4 ½ hours) from the time your stroke started. In fact, the sooner tPA is given, the better it works. Before you can get tPA, you need to be tested to make sure you're not having a hemorrhagic stroke because tPA can make hemorrhagic strokes worse. This is why it is so important for a person having a stroke to call 911 quickly.

Some people with ischemic stroke can't get tPA. They might have gotten to the hospital too late or have another medical condition. These people will receive a different treatment:

• Blood thinners. These medicines can improve your blood flow if you have a clot. If you have atrial fibrillation or a history of stroke, your doctor might put you on long-term blood thinner treatment to prevent another stroke in the future.
• Blood clot removal. Some people do not get to the hospital in time to receive tPA, or they were given tPA, but it didn't work. The doctor may use a device to remove the clot causing the blockage.

Hemorrhagic strokes are very dangerous and have fewer treatment options. Treatment usually involves trying to control the bleeding and reduce pressure with drugs or surgery. The type of treatment you'll receive depends on what caused the bleeding and whether the bleeding is inside or outside your brain tissue. The main options are:

• Drugs to lower blood pressure. High blood pressure is the most common cause of a hemorrhagic stroke. Usually, in these kinds of strokes, there are tiny leaks in blood vessels throughout the brain. Lowering your blood pressure can help heal the leaks.
• Surgery to release the extra blood. A lot of bleeding in your brain can cause pressure inside your skull that can damage your brain. Doctors may make a cut in your skull to release some of the blood and lower the pressure.
• Surgical clipping. This procedure is used to treat a stroke caused by an aneurysm in your brain that has burst open. Surgeons cut into your skull and use a metal clip to close the blood vessel that has burst.
• Endovascular coiling. This procedure is also used to treat a burst aneurysm. It doesn't involve opening the skull, so it can be less risky than surgical clipping. It also takes less time to recover afterward. In this surgery, the surgeon puts a long, thin tube called a catheter through a small cut in an artery. He or she moves the end of it to the aneurysm and releases small metal coils into the aneurysm. A blood clot forms around the coils and stops the bleeding.
• Procedures to correct abnormal blood vessels. Some hemorrhagic strokes are caused by abnormally shaped blood vessels. If the problem is close to the surface of the brain, surgery can correct it. For problems deeper in the brain, surgeons can use a catheter inserted through the groin to enter the blood vessels, block abnormal connections, and stop the bleeding.

After stroke treatment, you might also need rehabilitation to recover from the damage the stroke did to your brain.

1. Powers, W. J., Derdeyn, C. P., Biller, J., Coffey, C. S., Hoh, B. L., Jauch, E. C., … Yavagal, D. R., on behalf of the American Heart Association Stroke Council. (2015). 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 46(10), 3020–3035.