What is the best treatment for stroke?
The main treatment for an ischaemic stroke (blood clot) is a medicine called tissue plasminogen activator (tPA).
But there are many treatments including blood thinning drugs, thrombolysis (clot-busting drug), x-ray procedures and operations. The treatment depends on the cause, i.e whether it is an ischaemic (caused by a blood clot), haemorrhagic stroke (due to a bleed) or a TIA (mini-stroke).
Treatment for stroke
Blood-thinning (antiplatelet) drugs
If you have had an ischaemic stroke (due to a blood clot) or TIA (mini-stroke) you will usually be given a blood-thinning antiplatelet drug, usually aspirin. Antiplatelets help to stop more clots from forming in your blood and brain in the future.
Thrombolysis
Some people with ischaemic stroke are eligible for a clot-busting drug. The drug aims to disperse the clot and restore the blood supply to your brain. The most common medicine is called ‘alteplase’, or recombinant tissue plasminogen activator (rt-PA). The process of giving this medicine is known as ‘thrombolysis’.
For most people, thrombolysis needs to be given within 4-5 hours of your stroke symptoms starting. In some circumstances, your doctor may decide that it could still be of benefit after six hours However, the more time that passes, the less effective thrombolysis will be. This is why it’s important to get to the hospital as quickly as possible when your symptoms start.
After thrombolysis, 10% more patients survive and live independently. Despite its benefits, there is a small risk that thrombolysis can cause bleeding in your brain.
Surgery for stroke
Thrombectomy
Thrombectomy is a treatment that physically removes a clot from the brain. It usually involves inserting a mesh device into an artery in your groin, moving it up to the brain, and pulling the clot out. It only works with people where the blood clot is in a large artery.
Like thrombolysis, it has to be carried out within hours of a stroke starting. Only a small proportion of stroke cases are eligible for thrombectomy but it can have a big impact on those people by reducing disability.
Haemorrhagic stroke
If you have a haemorrhagic stroke (due to bleeding in or around the brain) you might be given treatment for high blood pressure. If you are on anticoagulants (strong blood thinning drugs) you’ will be given medication to reverse the effects and reduce bleeding.
If a bleed is due to a burst aneurysm (weakened blood vessel), you might have an x-ray procedure (called an endovascular ‘coil’) or operation to repair the blood vessel. This will stop it bleeding again.
To avoid further damage to the brain due to lack of blood supply, you may be given a drug called nimodipine.
Craniectomy (decompressive)
A few patients with stroke require surgery to reduce pressure caused by a build-up of fluid. One operation is called a ‘craniectomy’. This is an operation in which a neurosurgeon (brain surgeon) removes a section of a person’s skull. This is done to ease pressure on the brain that happens because of swelling or bleeding.
Summary
We have described the best treatments for stroke. A lot an be done. Treatments including blood thinning drugs, thrombolysis (clot-busting drug), x-ray procedures and operations – all can all be effective.
