Stroke - Treatment 

If you've had an ischaemic stroke, a combination of medications to treat the condition and prevent it happening again is usually recommended.

Some of these medications 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

Ischaemic strokes can often be treated using injections of a medication called alteplase, which dissolves blood clots and restores blood flow to the brain. This use of "clot-busting" medication is known as thrombolysis.

Alteplase is most effective if started as soon as possible after the stroke occurs. It isn't 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 carried out to confirm a diagnosis of an ischaemic stroke. This is because the medication can make the bleeding that occurs in haemorrhagic strokes worse.

Thrombectomy

A small proportion of severe ischaemic strokes can be treated by an emergency procedure known as 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 carried out under local or general anaesthetic.

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.

In addition to aspirin, other antiplatelet medicines such as clopidogrel and dipyridamole are also available.

Anticoagulants

Some people may be offered an anticoagulant to help reduce their risk of developing further blood clots in the future.

Anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots occurring.

Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban are examples of anticoagulants for long-term use.

There are also a number of anticoagulants called heparins that 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 that can cause blood clots
• have a history of blood clots
• develop a blood clot in your leg veins – known as deep vein thrombosis (DVT) – because a stroke has left you unable to move one of your legs

Antihypertensives

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
• beta-blockers
• alpha-blockers

Read more about treating high blood pressure.

Statins

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 isn't particularly high, as it may help reduce your risk of stroke whatever your cholesterol level is.

Carotid endarterectomy

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 particularly severe, surgery may be offered to unblock the artery. This is done using a surgical technique 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.

As with ischaemic strokes, some people who have had a haemorrhagic stroke will also be offered medication 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 medication and reduce your risk of further bleeding.

Surgery

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 cut away to allow the surgeon access to the cause 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 carried out 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 surgically placing an artificial tube called a shunt into the brain to allow the fluid to drain properly.

Read more about treating hydrocephalus.

As well as the treatments mentioned above, you may also 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 leg (deep vein thrombosis, or DVT)

Read more about recovering from a stroke.

The National Stroke Strategy, published in December 2007, provides a guide to high-quality health and social care for those affected by stroke.

Stroke experts have set out standards that define good stroke care, including:

• a rapid response to a 999 call for suspected stroke
• prompt transfer to a hospital providing specialist care
• an urgent brain scan – for example, CT scan or MRI scan undertaken as soon as possible
• immediate access to a high-quality stroke unit
• early multidisciplinary assessment, including swallowing screening
• specialised stroke rehabilitation
• planned transfer of care from hospital to community and longer-term support

The National Institute for Health and Care Excellence (NICE) has also produced guidelines on the diagnosis and management of stroke and a quality standard for stroke that describes the level of care the NHS is working towards.

If you're concerned about the standard of care provided, speak to your stroke specialist or a member of the stroke team.

Further reading

What social care services are available?

Practical support for carers

Care after discharge from hospital

Your guide to care and support