Stroke - Treatment 

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 and warfarin are two anticoagulants that are commonly used.

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. Two medicines that are commonly used are:

• thiazide diuretic: this reduces the amount of water in your body and widens the blood vessels, which decreases blood pressure 
• angiotensin converting enzyme (ACE) inhibitors: these widen the blood vessels and reduce 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.

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Emergency surgery is often needed to treat haemorrhagic strokes in order 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.

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.