Treatments for ischaemic stroke in the first few hours

What is thrombolysis?

If you’ve had an ischaemic stroke, you may be treated with a ‘clot-busting’ medicine (a thrombolytic) to try to dissolve the clot and open up the affected artery. This process is called thrombolysis.

To stand a good chance of working, thrombolysis must be given within 4.5 hours of the first symptoms of a stroke.

Thrombolysis is not suitable for everyone who has had a stroke:

  • If you do not know or are not able to tell the doctors when your symptoms first started you may not be suitable for thrombolysis.
  • Thrombolysis cannot be given if you have had a recent bleed, trauma or surgical operation.
  • Thrombolysis cannot be given if you are taking an anticoagulant (blood thinning) medicine, such as warfarin, apixaban, dabigatran, edoxaban or rivaroxaban.

Benefits of thrombolysis

Thrombolysis increases the chance of surviving a stroke and living independently by 10%.

Risks of thrombolysis

About 1 in 15 people who have thrombolysis develop bleeding in the brain. In some people this can be fatal.

What is thrombectomy?

Thrombectomy (or intra-arterial clot retrieval) is a procedure used to physically remove the clot that caused the stroke and open up the blocked artery.

During the procedure, a thin flexible tube (a catheter) is inserted into an artery in the top of your leg. The tube is carefully moved through the blood vessels in your body to the blocked artery in the brain. To guide the tube safely into place, a dye is injected into the tube and an x-ray used to track it.

When the tube is safely in place, a wire net (a stent retriever) is passed through the catheter to the site of the blockage. The wire net is used to remove the clot and re-establish blood flow through the artery to the affected part of your brain.

Thrombectomy is carried out in an operating theatre. Usually you will be awake during the procedure and have a local anaesthetic to numb your upper leg where the tube is inserted. Occasionally the procedure is done under a general anaesthetic.

Thrombectomy is not suitable for everyone who has had a stroke:

  • Thrombectomy is only possible when the blockage is in a large artery in the brain and is visible on a brain scan. Only 1 in 10 people who have an acute ischaemic stroke have a large artery blockage.
  • Thrombectomy can only be given in a hospital with specialist doctors who can perform the procedure. Therefore, you may need to be rapidly transferred from your local hospital to a specialist hospital.
  • Thrombectomy is most effective if it is done in the first few hours after a stroke.

Benefits of thrombectomy

Removing the clot early increases your chance of a better recovery, including the recovery of your independence and mobility. About 8 out of every 20 people who have a thrombectomy will have less disability compared with those who don’t undergo the procedure.

Risks of thrombectomy

Thrombectomy is a relatively safe procedure when performed by an experienced, appropriately trained doctor.

Risks of thrombectomy include:

  • An allergic reaction to the dye used to see the blood vessels on x-ray
  • Bruising or bleeding where the tube is inserted

Severe complications are rare, occurring in less than 1 in every 20 people who have a thrombectomy. They include:

  • Worsening of the stroke
  • Perforation of an artery leading to a bleed in the brain