Stroke - Treatment 

Treating stroke 

Effective treatment of stroke can prevent long-term disability and save lives.

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] or magnetic resonance imaging [MRI]) 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 Clinical Excellence (NICE) has produced a quality standard (PDF, 61Kb) for stroke that describes the level of care that 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.

    Ischaemic strokes  hide

    Ischaemic strokes can be treated using a 'clot-busting' medicine called alteplase, which dissolves blood clots (thrombolysis). However, alteplase is only effective if started during the first four and a half hours after the onset of the stroke. After that time, the medicine has not been shown to have beneficial effects. Even within this narrow time frame, the quicker alteplase can be started the better the chance of recovery. However, not all patients are suitable for thrombolysis treatment.

    You will also be given a regular dose of aspirin (an anti-platelet medication), as this makes the cells in your blood, known as platelets, less sticky, reducing the chances of further blood clots occurring. If you are allergic to aspirin, other anti-platelet medicines are available.

    Anticoagulants

    You may also be given an additional medication called an anticoagulant. Like aspirin, anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots from occurring. Heparin, warfarin and more recently rivaroxaban are examples of anticoagulants.

    Anticoagulants are often prescribed for people who have an irregular heartbeat that can cause blood clots.

    Blood pressure

    If your blood pressure is too high, you may be given 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 given 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.

    Carotid stenosis

    Some ischaemic strokes are caused by a narrowing in the carotid artery, which is an artery in the neck, which takes 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 bad, surgery may be used 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 in order to open up the carotid artery and remove the fatty deposits.

    back to top

    Haemorrhagic strokes show

    Emergency surgery is often needed to treat haemorrhagic strokes 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 small 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.

    Following a craniotomy, the patient may have to be placed on a ventilator. A ventilator is a machine that assists someone with their breathing. It gives the body time to recover by taking over its normal responsibilities, such as breathing, and it will help control any swelling in the brain.

    The patient will also be given medicines, such as ACE inhibitors, to lower blood pressure and prevent further strokes from occurring.

    back to top

    Transient ischaemic attack (TIA) show

    The treatment for a TIA involves addressing the risk factors that may have led to it, to try to prevent a bigger, more serious stroke.

    If you have a TIA, the treatment you receive will depend on what caused it, but you will typically be given one of the medicines outlined above or a combination of them. So, if high blood pressure and high cholesterol levels put you at risk of having a stroke, you may be given a combination of statins and ACE inhibitors.

    If the risk of a stroke is high due to a build-up of fatty plaques in your carotid artery, a carotid endarterectomy may be required.

    back to top

    Page last reviewed: 29/08/2012

    Next review due: 29/08/2014

    Ratings

    How helpful is this page?

    Average rating

    Based on 80 ratings

    All ratings

    Add your rating

    Comments

    Stroke: patients' stories

    In this video, patients reveal how a stroke affected their lives, how it continues to impact on them, and their individual treatments.

    Media last reviewed: 19/03/2013

    Next review due: 19/03/2015

    Call 999

    • by calling 999 you can help someone reach hospital quickly and receive the early treatment they need
    • prompt action can prevent further damage to the brain and help someone make a full recovery
    • delay can result in death or major long-term disabilities, such as paralysis, severe memory loss and communication problems

    Find out how your local NHS manages stroke care