Stroke - Treating stroke

Treating ischaemic strokes

If you have had an ischaemic stroke, a combination of medications to treat the condition and prevent it from happening again will usually be recommended.

Some of these medications will 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 in the long-term.

Thrombolysis

Ischaemic strokes can often be treated using injections of a medication called alteplase that dissolves blood clots and restores the flow of blood 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 and is not generally recommended if more than four and a half hours have passed because it's not clear how beneficial it is when used after this time.

However, before alteplase can be used, it is very important that a brain scan to confirm a diagnosis of an ischaemic stroke is carried out because the medication can make the bleeding that occurs in haemorrhagic strokes worse.

Antiplatelets

Most people will also be offered a regular dose of aspirin which – as well as being a painkiller – makes the cells in your blood called platelets less sticky, reducing 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 also be offered an additional medication called 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 from occurring. Warfarin, rivaroxaban, dabigatran and apixaban 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 in the 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
are at risk of developing clots 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 will be advised to take a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol.

You may be offered a statin even if your cholesterol level is not particularly high, because a statin 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 an 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 medication, such as ACE inhibitors, to lower blood pressure and prevent further strokes from occurring.

If you were previously taking anticoagulant medicine 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, 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.

Supportive treatments

In addition to 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 are malnourished
fluids given directly into a vein (intravenously) if you are at risk of dehydration
oxygen through a nasal tube or face mask if you have low levels of oxygen in your blood

For more information about the supportive treatments you may need in the long-term to help you manage the lasting effect of a stroke, see recovering from a stroke.

What is good stroke care?

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 which 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, computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan undertaken as soon as possible
immediate access to a high quality stroke unit
early multidisciplinary assessment, including swallowing screening
stroke specialised 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 are concerned about the standard of care provided, speak to your stroke specialist or a member of the stroke team.