Treating ischaemic strokes
If you have had an ischaemic stroke, a combination of medicines to treat the condition and prevent it happening again is usually recommended.
Some of these medicines need to be taken immediately and only for a short time, while others may only be started once the stroke has been treated and may need to be taken long term.
Thrombolysis - "clot buster" medicine
Ischaemic strokes can often be treated using injections of a medicine called alteplase, which dissolves blood clots and restores blood flow to the brain.
This use of "clot-busting" medicine is known as thrombolysis.
Alteplase is most effective if started as soon as possible after the stroke occurs - and certainly within 4.5 hours.
It's not generally recommended if more than 4.5 hours have passed, as it's not clear how beneficial it is when used after this time.
Before alteplase can be used, it's very important that a brain scan is done to confirm a diagnosis of an ischaemic stroke.
This is because the medicine can make the bleeding that occurs in haemorrhagic strokes worse.
A small number of severe ischaemic strokes can be treated by an emergency procedure called a thrombectomy.
This removes blood clots and helps restore blood flow to the brain.
Thrombectomy is only effective at treating ischaemic strokes caused by a blood clot in a large artery in the brain.
It's most effective when started as soon as possible after a stroke.
The procedure involves inserting a catheter into an artery, often in the groin. A small device is passed through the catheter into the artery in the brain.
Aspirin and other antiplatelets
Most people will be offered a regular dose of aspirin. As well as being a painkiller, aspirin is an antiplatelet, which reduces the chances of another clot forming.
Some people may be offered an anticoagulant to help reduce their risk of developing new blood clots in the future.
Anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots from forming.
Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban are examples of anticoagulants for long-term use.
There are also a number of anticoagulants called heparins, which can only be given by injection and are used short term.
Anticoagulants may be offered if you:
- have a type of irregular heartbeat called atrial fibrillation, which can cause blood clots
- have a history of blood clots
- develop a blood clot in your leg veins (deep vein thrombosis (DVT)) because a stroke has left you unable to move one of your legs
Blood pressure medicines
If your blood pressure is too high, you may be offered medicines to lower it.
Medicines that are commonly used include:
- thiazide diuretics
- angiotensin-converting enzyme (ACE) inhibitors
- calcium channel blockers
If the level of cholesterol in your blood is too high, you'll be advised to take a medicine known as a statin.
Statins reduce the level of cholesterol in your blood by blocking a chemical (enzyme) in the liver that produces cholesterol.
You may be offered a statin even if your cholesterol level is not particularly high, as it may help reduce your risk of stroke whatever your cholesterol level is.
Some ischaemic strokes are caused by narrowing of an artery in the neck called the carotid artery, which carries blood to the brain.
The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques.
If the carotid stenosis is very severe, surgery may be used to unblock the artery. This is called a carotid endarterectomy.
It involves the surgeon making a cut (incision) in your neck to open up the carotid artery and remove the fatty deposits.
Treating haemorrhagic strokes
As with ischaemic strokes, some people who have had a haemorrhagic stroke will also be offered medicine to lower their blood pressure and prevent further strokes.
If you were taking anticoagulants before you had your stroke, you may also need treatment to reverse the effects of the medicine and reduce your risk of further bleeding.
Occasionally, emergency surgery may be needed to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.
During a craniotomy, a section of the skull is removed to allow the surgeon access to the source of the bleeding.
The surgeon will repair any damaged blood vessels and ensure there are no blood clots present that may restrict the blood flow to the brain.
After the bleeding has been stopped, the piece of bone removed from the skull is replaced, often by an artificial metal plate.
Surgery for hydrocephalus
Surgery can also be done to treat a complication of haemorrhagic strokes called hydrocephalus.
This is where damage resulting from a stroke causes cerebrospinal fluid to build up in the cavities (ventricles) of the brain, causing symptoms such as headaches, sickness, drowsiness, vomiting and loss of balance.
Hydrocephalus can be treated by putting a tube, called a shunt, into the brain to allow the fluid to drain.
You may need further short-term treatment to help manage some of the problems that can affect people who have had a stroke.
For example, you may require:
- a feeding tube inserted into your stomach through your nose (nasogastric tube) to provide nutrition if you have difficulty swallowing (dysphagia)
- nutritional supplements if you're malnourished
- fluids given directly into a vein (intravenously) if you're at risk of dehydration
- oxygen through a nasal tube or face mask if you have low levels of oxygen in your blood
- compression stockings to prevent blood clots in the legs (DVT)