The main treatments aiming to break up or remove clots from the brain are usually only available within a few hours of a stroke. But there is also a range of other types of care, including medication to reduce your blood pressure and reduce your risk of another stroke.
You will be monitored for signs of complications and given any treatment you need. You will be assessed to find out how the stroke has affected you and what help you need with your recovery.
Treatments to break up or remove clots
There are two ways of treating clots in the brain:
- Thrombolysis uses a clot-busting medicine to break up clots in brain blood vessels and restore blood flow.
- Thrombectomy removes the blood clot to help reduce brain damage by restoring blood flow in the brain.
What happens if the clot is not treated?
Clot removal and clot-busting treatment are effective at reducing disability after stroke, but at present only around 10-15% of people are able to have them. These treatments are given on top of the standard stroke care, which includes tests, medication and therapy.
Without removal or clot-busting treatment, the blood clot usually breaks up naturally within a few days or weeks. You will be assessed to find out how the stroke is affecting you.
You will be supported to recover by specialist doctors, nurses and therapists working in a team to give you expert care. You will also be given treatments to reduce your risk of another stroke, such as blood-thinning medications and treatment for high blood pressure.
Surgery: decompressive hemicraniectomy
When the brain is injured, the tissues can swell, just like a bruise. If there is a lot of swelling, it can put pressure on other areas of your brain, causing further damage.
In a very small number of cases, an operation may be needed to relieve pressure on your brain. A decompressive hemicraniectomy involves opening up a section of your skull to allow the brain to swell outwards and relieve some of the pressure.
Treatments to reduce the risk of another stroke
Medication
Most people who have an ischaemic stroke will be given blood-thinning medication to help prevent clots from forming. If you receive thrombolysis, you normally have to wait at least 24 hours before you can begin taking blood thinners. Most people will need to take blood-thinning medication for life.
There are two types of blood-thinning medication, antiplatelets and anticoagulants. For most people, an antiplatelet drug will be used, typically a daily dose of clopidogrel. Some people may be given a short course of two antiplatelet drugs, such as clopidogrel and aspirin. For some people with certain gene variations, clopidogrel may be less effective and you may be offered testing just after a stroke to see if an alternative antiplatelet may be more suitable for you.
Surgery for narrowed arteries in the neck (carotid artery disease)
Around 15% of ischaemic strokes are due to narrowed arteries in the neck, known as carotid artery disease. This is diagnosed using specialist scans of your neck. Carotid artery disease is due to atherosclerosis, the build-up of fatty materials in your arteries.
Carotid artery disease is sometimes treated using a surgical procedure. This means either removing the artery lining or inserting a mesh cylinder (stent) to keep the artery open. You’ll be assessed to decide on the best treatment to help reduce your risk of a stroke, which might include medication instead of surgery.
Your care in the first 24 hours after a stroke
The team on the stroke unit will continue to monitor you closely for at least 24 hours to ensure you remain stable. You should have a swallowing test within four hours of being in hospital, to make sure it’s safe for you to eat and drink or take medicine by mouth. If you cannot eat or drink safely, you may need a thin tube inserted via your nose into your stomach (naso-gastric tube), to allow liquids and drugs to be given.
You may see some signs of recovery from your stroke early on, but if you’re still showing effects after 24 hours, you will have a full assessment with all the professionals on the stroke team. The team may include a physiotherapist, speech and language therapist, occupational therapist, dietitian, orthoptist and a psychologist.
After 24 hours, you will be supported to get up, or walk around if it is safe for you to do so. If you’re not able to move about very much, the way you are positioned is very important to help you avoid problems with breathing, chest infections (pneumonia), shoulder pain or pressure sores.
Your stroke team will work with you to find the best position for you to sit or lie down and help you to move at regular intervals.
Rehabilitation
You should receive rehabilitation soon after your stroke if you have stroke-related problems. It should begin in hospital and carry on at home for as long as you need it. Rehabilitation is part of recovery. It means trying to restore function to as near normal as possible, and helping you adapt to disability.
A therapist will assess you and work with you to set goals. Depending on the type of therapy, you may have exercises or activities to practise.
Many people tell us they worry about whether they will have another stroke. This can be part of the emotional impact of stroke on you, your family and friends.
Having a stroke or transient ischaemic attack (TIA) means that you are at greater risk of having another stroke. The risk is highest in the days and weeks after a stroke, which is why doctors work so hard to reduce your risk early on.
Brain scans and other tests and checks will take place, to try to find out what caused your stroke and help doctors to target your treatment. After an ischaemic stroke, you will be given medicine to avoid blood clots forming.
If you have a health condition linked to stroke, such as high blood pressure, you will be given any treatment and advice you need to help you avoid another stroke. One of the best ways to reduce your risk is to carry on with any treatment you’re given.
As soon as you are well enough, your doctor should talk to you about what may have caused your stroke and things you can do to reduce the risk of it happening again. This could mean taking medication, making changes to your lifestyle, or both.
Take a look at our Managing risk section for more information and tips.