Are all ischemic strokes the same?
There are two main types of ischemic strokes.
- Thrombotic strokes are caused by a blood clot (thrombus) in an artery going to the brain. The clot blocks blood flow to part of the brain. Blood clots usually form in arteries damaged by plaque.
- Embolic strokes are caused by a wandering clot (embolus) that’s formed elsewhere (usually in the heart or neck arteries). Clots are carried in the bloodstream and block a blood vessel in or leading to the brain.
When someone has shown symptoms of a stroke or a TIA (transient ischemic attack), a doctor will gather information and make a diagnosis. He or she will review the events that have occurred and will:
- get a medical history from you or a family member
- do a physical and neurological examination
- have certain laboratory (blood) tests done
- get a CT or MRI scan of the brain
- study the results of other diagnostic tests that might be needed
How are ischemic strokes treated?
Acute treatment is the immediate treatment given by the healthcare team when a stroke happens. The goal of acute treatment is to keep the amount of brain injury as small as possible. This is done by restoring blood flow to the part of the brain where the blockage was quickly.
The only FDA approved drug to treat ischemic stroke is tissue plasminogen activator (tPA). It is a clot busting drug. tPA must be given within 3 to 4.5 hours of the first symptoms of stroke. Medication may also be used to treat brain swelling that sometimes occurs after a stroke.
For people with blood clots in larger arteries, tPA often does not dissolve them completely. In this case, a procedure, called mechanical thrombectomy, should be done within six hours of the first symptoms of stroke. In most cases this is done only after the patient receives IV tPA. To remove the clot, doctors thread a catheter (thin tube) with a stent through an artery in the groin up to the blocked artery in the brain. The stent opens and grabs the clot. The doctors then remove the stent with the trapped clot. If necessary, other devices may also be used.
When someone has a stroke, they are at risk of another. Once the medical team identifies what caused the stroke, they may prescribe treatments or procedures to reduce the risk of a second stroke, such as:
- Antiplatelet agents such as aspirin and anticoagulants such as warfarin, dabigitran, apixaban, rivoraxaban or edoxaban interfere with the blood's ability to clot. This can play an important role in preventing a stroke.
- Carotid endarterectomy is a procedure in which blood vessel blockage (blood clot or fatty plaque) is surgically removed from the carotid artery in the neck. This reopens the artery and the blood flow to the brain. This is only done in people who have a large blockage.
- Doctors sometimes use balloon angioplasty and implantable steel screens called stents to treat and reduce fatty buildup clogging a vessel that may make it easy for clots to form in the bloodstream.
Sometimes a stroke is the first sign a person has of other health conditions, such as high blood pressure, diabetes, atrial fibrillation (a heart rhythm disorder) or other vascular disease. If any of these are diagnosed, the healthcare team will prescribe appropriate treatment.
How can I learn more?
- Call 1-888-4-STROKE (1-888-478-7653) to learn more about stroke or find local support groups, or visit StrokeAssociation.org.
- Sign up to get Stroke Connection magazine, a free magazine for stroke survivors and caregivers at strokeconnection.org.
- Connect with others sharing similar journeys with stroke by joining our Support Network at strokeassociation.org/supportnetwork.
We have many other fact sheets to help you make healthier choices to reduce your risk, manage disease or care for a loved one. Visit strokeassociation.org/letstalkaboutstroke to learn more.Do you have questions for your doctor or nurse?
Take a few minutes to write your own questions for the next time you see your healthcare provider:
What can I do to help prevent another stroke?
What medications may I be given?
©2015, American Heart Association