Stroke diagnosis and treatment during coronavirus (COVID-19) pandemic
At this time, hospitals are working in new ways to deliver emergency treatment and post-stroke care while avoiding infection. Read our latest information about post-stroke care to find out more.
If you have had an ischaemic stroke (due to a clot) you will usually be given an antiplatelet drug, usually aspirin. Antiplatelets help to stop clots forming in your blood.
Some people with ischaemic stroke are eligible for a clot-busting drug. The drug aims to disperse the clot and return the blood supply to your brain.
The medicine itself is called alteplase, or recombinant tissue plasminogen activator (rt-PA). The process of giving this medicine is known as thrombolysis.
Thrombolysis can break down and disperse a clot that is preventing blood from reaching your brain.
For most people thrombolysis needs to be given within four and a half hours of your stroke symptoms starting. In some circumstances, your doctor may decide that it could still be of benefit within six hours. However, the more time that passes, the less effective thrombolysis will be. This is why it’s important to get to hospital as quickly as possible when your symptoms start.
After thrombolysis, 10% more patients survive and live independently. Despite its benefits, there is a risk that thrombolysis can cause bleeding in your brain. This happens to about one in 25 people within seven days of thrombolysis, and this can be fatal in about one in 40 cases. The sooner you are treated, the better the chances of improvement, and the lower the risk of harm.
Who can have thrombolysis?
Not everyone who has an ischaemic stroke is suitable for thrombolysis. At present around 12% of people who are admitted to hospital with a stroke are eligible to receive it. If you are not suitable, it may be because:
- You had a bleed in the brain.
- You do not know or cannot tell doctors when your symptoms began.
- You do not reach hospital in time.
- You have a bleeding disorder.
- You have recently had major surgery.
- You have had another stroke or head injury within the past three months.
- Your current medication is not compatible with alteplase.
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.
If you have a haemorrhagic stroke (due to bleeding in or around the brain) you might be given treatments for high blood pressure. If you're on anticoagulants you'll 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 a surgical procedure to repair the blood vessel. Surgery is also used to reduce pressure caused by a build-up of fluid.
To avoid further damage to the brain due to lack of blood supply, you may be given a drug called nimodipine.
You'll be given pain relief to help with the headaches that a bleed can cause.