Imaging techniques also assist in determining the subtypes and cause of stroke. [91] Surgery is most efficient when not delayed too long—the risk of recurrent stroke in a person who has a 50% or greater stenosis is up to 20% after 5 years, but endarterectomy reduces this risk to around 5%. Blood within the atria is not completely emptied. Ideally, the patient will achieve sufficient independence to return to community living, either independently or with family and community support. The incidence of stroke has gradually declined during the past generation. Rehabilitation services may be provided in an acute care hospital, rehabilitation hospital, long-term care facility, outpatient clinic, or at home. Limiting factors in the use of thrombolytic therapy are the need to rule out hemorrhagic stroke (sometimes difficult with available imaging methods) and the fact that the therapy itself may induce hemorrhage.

", "The Case Against Thrombolytic Therapy in Stroke", "Efficacy of intra-arterial fibrinolysis for acute ischemic stroke: meta-analysis of randomized controlled trials", "Endovascular therapy for acute ischaemic stroke: a systematic review and meta-analysis of randomized trials", "Surgical trials in intracerebral hemorrhage", "European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage", "Organised inpatient (stroke unit) care for stroke: network meta-analysis", "Reliability (inter-rater agreement) of the Barthel Index for assessment of stroke survivors: systematic review and meta-analysis", "Physical rehabilitation approaches for the recovery of function and mobility following stroke", "Interventions for treating urinary incontinence after stroke in adults", "Interventions for sexual dysfunction following stroke", "Dysarthria in stroke: a narrative review of its description and the outcome of intervention", "Swallowing therapy for dysphagia in acute and subacute stroke", "Physical fitness training for stroke patients", "After a stroke: Does fitness training improve overall health and mobility? Glutamate acts on receptors in nerve cells (especially NMDA receptors), producing an influx of calcium which activates enzymes that digest the cells' proteins, lipids, and nuclear material. Delivered to your inbox! NCHS Data Brief, No. [108] Thienopyridines (clopidogrel, ticlopidine) might be slightly more effective than aspirin and have a decreased risk of gastrointestinal bleeding, but are more expensive.