Effective treatment of stroke can prevent long-term disability and save lives.
The treatments you need depends on whether a stroke is caused by:
- a blood clot blocking the flow of blood to the brain (ischaemic stroke)
- bleeding in or around the brain (haemorrhagic stroke)
Treatment usually involves taking 1 or more medicines. Some people may also need surgery.
Treating ischaemic strokes
A combination of medicines is usually used to treat an ischaemic stroke and to prevent it happening again. You may need to take some of these medicines immediately, and only for a short time. You may need to take other medicines for a longer time after your stroke has been treated.
Some people with ischaemic stroke can benefit from urgent blood clot-busting medicine (thrombolysis) or a procedure to remove the blood clot (thrombectomy). These treatments need to be given urgently to have the best chance of working well.
Ischaemic strokes can sometimes be treated using a medicine called alteplase or tenecteplase. This dissolves blood clots and restores blood flow to the brain.
This use of 'clot-busting' medicine is known as thrombolysis.
Thrombolysis works best if it is given as soon as possible after the stroke. It may not be recommended if more than 4.5 hours have passed, or if you are already taking anticoagulant (blood thinning) medicine.
You will need to have a brain scan before you get thrombolysis. This is to rule out a haemorrhagic stroke. Thrombolysis can make the bleeding in haemorrhagic strokes worse.
A small proportion 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.
The blood clot can then be removed using the device or through suction. The procedure can be done under local anaesthetic.
Most people will be offered a regular dose of aspirin. As well as being a painkiller, aspirin is an antiplatelet medicine. This lowers the chances of another clot forming.
Some people may be offered an anticoagulant. This is to help lower your 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 anticoagulants called heparins that can only be given by injection and are used short term.
Anticoagulants may be given to you if you:
- have a type of irregular heartbeat called atrial fibrillation that can cause blood clots
- have a history of blood clots
- have or had a blood clot in your leg or your lung
- have a mechanical heart valve
Antihypertensives - blood pressure medicines
If your blood pressure is too high, you will be prescribed medicines to lower it.
Medicines that are commonly used include:
- angiotensin-converting enzyme (ACE) inhibitors
- calcium channel blockers
- beta blockers
- alpha blockers
- thiazide diuretics
Medicines to lower cholesterol
In certain situations you may have an injection called a PCSK9 inhibitor.
You may be offered these medicines even if your cholesterol is not high. They can help reduce your risk of stroke.
Some ischaemic strokes are caused by narrowing of an artery in the neck called the carotid artery. This carries blood to the brain.
A build-up of fatty deposits in the arteries called plaques cause them to narrow. This is known as carotid stenosis.
If the carotid stenosis is particularly severe, you may have surgery to unblock the artery (carotid endarterectomy). The surgeon will make a cut (incision) in your neck to open up the carotid artery and remove the fatty deposits.
Treating haemorrhagic strokes
If you have a haemorrhagic stroke, you will be given medicine to lower your 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
- reduce your risk of further bleeding
Sometimes emergency surgery may be needed to remove blood from the brain and repair any burst blood vessels.
This is usually done by one of the following:
- a minimally invasive approach to remove the blood
- a bigger surgery that removes part of the skull (craniotomy)
During a craniotomy, a part of the skull is cut away to give the surgeon access to the affected area.
The surgeon will repair any damaged blood vessels. They will make sure there are no blood clots that could restrict the blood flow to the brain.
After the bleeding has been stopped, the piece of the skull is replaced, often by a metal plate. This may be done months later when the swelling has gone down.
Surgery for hydrocephalus
Surgery can treat a complication of strokes called hydrocephalus.
This is where damage from a stroke causes cerebrospinal fluid to build up in the cavities (ventricles) of the brain.
This causes symptoms such as:
- loss of balance
Hydrocephalus can be treated by placing a tube into the brain to allow the fluid to drain.
You may also need further short-term treatment to help manage other problems after a stroke.
You may need:
- a feeding tube inserted into your stomach through your nose (nasogastric or NG tube) or directly through the stomach wall (PEG tube) - this provides nutrition if you have trouble swallowing
- nutritional supplements if you're malnourished
- fluids directly into a vein if you're at risk of dehydration
- oxygen given through a nasal tube or face mask if you have low levels of oxygen in your blood
- intermittent pneumatic compression (IPC) stockings to prevent blood clots in the leg