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If you or someone you love has had a stroke, you’ve probably heard: Time is brain. For every minute a stroke goes untreated, nearly 2 million brain cells die. “The impact of the damage from

stroke on a person’s life cannot be overstated,” says Laura K. Stein, M.D., a vascular neurologist, stroke health services researcher and associate professor of neurology at the Icahn School

of Medicine at Mount Sinai. “Every minute that goes by increases the chance of permanent brain damage and that a patient will not be able to do the things we take for granted every day,”

such as getting dressed, eating, walking and talking. Given the race against time, you might assume that the treatment options are few to none for the approximately 795,000 U.S. adults who

have a stroke each year. Not so. Treatment following a stroke usually occurs in three stages: immediate medical or surgical care to minimize the extent of damage to the brain; treatment to

prevent another stroke; and rehabilitation to manage the changes in ability. WHAT IS THE BEST TREATMENT FOR STROKE? Treatment options depend on the type of stroke: ischemic or hemorrhagic.

An ischemic stroke, by far the more common of the two, occurs when blood flow to the brain is blocked or reduced. The blockage could come from a blood clot in an artery wall or an embolism,

typically caused when a blood clot breaks off from another site and travels up into the brain, depriving the brain of oxygen and the nutrients it needs. A hemorrhagic stroke happens when a

weakened blood vessel bursts in or on the surface of the brain, damaging brain cells as a result. Independent of whether the stroke is ischemic or hemorrhagic, however, treatment for a

stroke quite literally can’t begin soon enough. So it’s important to call 911 right away if you see any signs of a stroke, rather than try to drive yourself or have someone else drive you to

the hospital. “Calling 911 is strongly recommended if you suspect a stroke, and one major reason is that EMTs [emergency medical technicians] can begin critical prehospital care

immediately, which can make a big difference in outcomes,” says Jayne Zhang, M.D., attending physician of neurology at Johns Hopkins School of Medicine. For instance, the EMT can monitor

blood pressure, oxygen levels, heart rhythm and blood glucose (since low blood sugar can mimic stroke symptoms), assess symptoms using tools — like the Cincinnati Prehospital Stroke Scale,

or what’s known as B.E.F.A.S.T. (short for “balance, eyes, face drooping, arm weakness, speech, time”) to quickly identify signs of stroke — and possibly begin treatment, Zhang says. If

that’s not possible, “EMTs can alert the hospital stroke team before arrival so they’re ready with a stroke protocol, shaving off critical minutes.” TREATMENTS FOR ISCHEMIC STROKE The goal

of treatment for an ischemic stroke is to restore blood flow to the brain. To that end, doctors will typically use one of two methods to remove the blockage: medication to dissolve it or

surgery to remove it. Much of their decision comes down to how quickly you get to the hospital. Typically, if you arrive within 4½ hours from the onset of stroke symptoms, the team will

evaluate you as a candidate for a type of clot-busting drug called tPA (short for “tissue plasminogen activator”). There are two forms of tPA, and both are given through an IV in the arm,

but tenecteplase is administered as a quick IV injection, while alteplase is given intravenously over the course of an hour. Research shows both are equally effective.