Treating Acute Ischemic Stroke

When a stroke is caused by a blocked blood vessel in the brain, every minute without treatment causes irreversible damage. The good news: with fast recognition and rapid treatment, many strokes can be stopped in their tracks — and serious disability can be prevented. At UNMH, our stroke team is mobilized the moment a stroke patient arrives, 24 hours a day, every day of the year.

Why Speed Is Everything: Time Is Brain

In an ischemic stroke, a blocked artery cuts off blood flow to a region of the brain. Brain cells in the core of that region begin dying almost immediately. Surrounding the core is a zone of injured but potentially salvageable brain tissue — called the penumbra — that is in a race against time. The faster blood flow is restored, the more of this tissue survives, and the better the patient's outcome.

This is why calling 911 at the first sign of stroke — rather than waiting to see if symptoms improve or driving yourself — is so critical. Emergency medical teams notify the hospital while en route, so our stroke team is ready and waiting before you arrive.

Code Stroke at UNMH:  UNMH's stroke team activates a 'Code Stroke' the moment a patient with stroke symptoms arrives in the emergency department. Within minutes, a CT scan of the brain is performed, the results are reviewed by the stroke team, and a treatment plan is underway. Our goal is to have eligible patients treated in under 60 minutes — and we consistently aim for under 45 minutes.

Treatment 1: Clot-Dissolving Medication (Thrombolytics)

The first treatment option for ischemic stroke is a clot-dissolving medication given directly into a vein in the arm. This medication works by breaking up the blood clot that is blocking the artery, restoring blood flow to the affected area of the brain. Speed is essential: the earlier this medication is given, the more effective it is.

Tenecteplase (TNK) — The Medication We Use

UNMH uses tenecteplase (TNK), a newer clot-dissolving agent that has significant advantages over the older standard medication. TNK is given as a single injection rather than a prolonged infusion, which means treatment can begin faster. Studies suggest it may be at least as effective — and in some situations more effective — than older thrombolytics, particularly in patients with large vessel occlusions who are also going on to receive thrombectomy.

Standard Treatment Window: Within 4.5 Hours

For most patients, thrombolytic medication is most effective and safest when given within 4.5 hours of when stroke symptoms first began. This is the standard treatment window followed at stroke centers across the country. Not every patient qualifies — the stroke team will quickly review your history, current medications, and imaging results to determine if thrombolytics are appropriate for you.

Extended Treatment Window: 4.5 to 24 Hours — Advanced Imaging Guided

One of the ways UNMH goes beyond standard care is our use of thrombolytics in carefully selected patients beyond the standard 4.5-hour window — up to 24 hours after stroke onset.

This is possible because of advanced brain imaging. Not all stroke patients are the same: some people have a large area of brain tissue that is injured but still alive — what we call 'tissue at risk' or the penumbra. Using specialized CT perfusion imaging or Hyperacute MRI brain, our team can identify these patients and determine whether their brain tissue is still salvageable even hours after symptom onset.

This extended-window approach is supported by landmark clinical research and reflects the most current evidence in stroke medicine. It means that patients who wake up with stroke symptoms (and cannot pinpoint exactly when the stroke started), or who delayed seeking care, may still be candidates for clot-dissolving treatment — when imaging shows their brain tissue can still be saved.

Important:  Not every patient with a late-presenting stroke will qualify for extended-window thrombolytics. Eligibility is determined by a combination of clinical factors and advanced imaging results, reviewed immediately by our stroke team. The key message: never assume it is 'too late' to seek care. Call 911 and let our team assess you.

Treatment 2: Mechanical Thrombectomy — Removing the Clot Directly

For strokes caused by a blockage in a large blood vessel — called a large vessel occlusion (LVO) — the most effective treatment is mechanical thrombectomy: a minimally invasive procedure in which a specialist physically removes the clot from the blocked artery.

During the procedure, a thin, flexible tube (catheter) is guided through a small puncture in the wrist or groin, up through the body's blood vessels, and into the blocked artery in the brain. A specialized device is then used to grab and pull out the clot, restoring blood flow. Most patients are under light sedation or general anesthesia during the procedure, which typically takes between 30 minutes and two hours depending on the complexity of the case.

The results of thrombectomy can be dramatic. Patients who arrive unable to speak or move an arm sometimes walk out of the hospital days later. While not everyone recovers fully, thrombectomy offers the best chance of meaningful recovery for patients with large vessel strokes.

Available 24 Hours a Day, 7 Days a Week — Only at UNMH

UNMH Advantage:  UNMH is the only hospital in New Mexico that offers mechanical thrombectomy around the clock, every day of the year. Our neurointerventional team is on call at all times — nights, weekends, and holidays — so that no patient in New Mexico has to wait until morning for a life-saving procedure.

Treatment Window: Up to 24 Hours in Selected Patients

The treatment window for thrombectomy is longer than for thrombolytics. For selected patients, thrombectomy can be performed up to 24 hours after symptom onset — again guided by advanced imaging that identifies salvageable brain tissue. This extended window, established by landmark clinical trials, has transformed care for patients who wake up with a stroke or present late to the hospital.

Even so, faster is always better. The difference between a 60-minute and a 90-minute door-to-treatment time can mean the difference between mild weakness and permanent paralysis. Our team works urgently to minimize every minute of delay.

At a Glance: Acute Ischemic Stroke Treatments

What About Hemorrhagic Stroke?

The treatments described on this page — thrombolytics and thrombectomy — are specific to ischemic stroke (stroke caused by a blockage). They must NOT be used in hemorrhagic stroke (stroke caused by bleeding), where they would dramatically worsen the outcome. This is why the first priority at any Comprehensive Stroke Center is an immediate brain CT scan — to confirm the type of stroke before any treatment is given. Learn about hemorrhagic stroke.

What to Expect When You Arrive

Here is what happens when a stroke patient arrives at the UNMH Emergency Department:

• Step 1: Immediate triage — You are seen immediately — stroke patients do not wait. A 'Code Stroke' is called.
• Step 2: Rapid imaging — A CT scan of your brain is performed within minutes to confirm the stroke type and identify which blood vessel is affected. In many cases, advanced CT perfusion or MRI imaging is also performed to assess how much brain tissue may still be salvageable.
• Step 3: Team evaluation — The stroke team — including a vascular neurologist and, if needed, a neurointerventional specialist — reviews your imaging and history to determine the fastest, safest treatment plan.
• Step 4: Treatment begins — If you are a candidate for TNK, it is given right away. If you need thrombectomy, the neurointerventional team is activated simultaneously so there is no delay between thrombolytics and the procedure.
• Step 5: Neurocritical care — After treatment, you are monitored closely in our neurocritical care unit or stroke unit, where nurses and physicians specializing in brain and nervous system care watch your recovery around the clock.
• Step 6: Stroke work-up & prevention — While you recover, our team investigates the cause of your stroke — through heart monitoring, vascular imaging, and blood tests — so we can start the right prevention strategy before you leave the hospital. 

For Families:  Family members and caregivers: if your loved one is being treated for a stroke, a member of our team will keep you updated throughout the process. Ask the charge nurse or social worker about family waiting areas and support resources. Our stroke coordinators are also available to answer your questions.

UNMH: New Mexico's Comprehensive Stroke Center

As New Mexico's only Comprehensive Stroke Center, UNMH has both the expertise and the technology to provide the most advanced acute stroke treatment available — including extended-window thrombolytics, 24/7 mechanical thrombectomy, and the full range of neurocritical care. Our team treats approximately 800 stroke patients per year, giving us the experience and systems to act with precision under pressure.