A stroke happens when oxygen-rich blood cannot reach the brain cells, often due to blockage or damage of a blood vessel. This loss of oxygen damages brain cells within minutes, which then start dying. Occurring mostly in older adults, a stroke is a serious medical emergency.…
What is ischaemic stroke?
There are two main types of stroke: ischaemic stroke and hemorrhagic stroke. Ischaemic strokes account for about 80% of all stroke cases. An ischaemic stroke occurs when an artery supplying oxygen-rich blood into the brain is blocked and oxygen cannot reach the brain tissue.
This page details the types of ischaemic stroke and the treatment given. For more information on stroke signs and symptoms, diagnosis, complications and rehabilitation, see our stroke report.
A thrombotic stroke is caused by a blood clot that forms within an artery in the brain. It arises from fatty deposits (plaques) that build up inside the artery, a condition known as atherosclerosis. These plaques can rupture, which creates a surface for a blood clot to form. This clot can completely block the artery.
Large arteries of the brain, which are the main blood supply to the brain, are more likely to be blocked by thrombotic strokes than embolic strokes. This is why a thrombotic stroke is most likely to have larger-scale effects.
Thrombotic strokes account for more than half of all strokes.
An embolic stroke is caused by a blood clot that travels from elsewhere in the body and lodges in an artery in the brain. The blood clot (embolus) that causes the stroke is commonly the result of existing heart problems, such as atrial fibrillation or aortic stenosis (the abnormal narrowing of the aortic valve).
Transient ischaemic attack
A transient ischaemic attack (TIA), also known as a 'mini-stroke', is caused by a temporary blockage or narrowing in a blood vessel leading to the brain. A person experiencing TIA will have signs and symptoms like those of a stroke, but will recover within minutes or a few hours.
It is important to note that a TIA is a warning sign. TIAs occur when the blood vessels feeding the brain are not in good condition; a person who has had a TIA is at risk of stroke, often within days of the TIA.
For more information on TIAs, see our transient ischaemic attack report.
Types of treatment
Once an ischaemic stroke is diagnosed, medicines are injected into the bloodstream that will dissolve the blood clot, prevent it from growing bigger and prevent other clots forming. These include:
- Tissue plasminogen activator (tPA), a substance that dissolves blood clots,  currently the best treatment for ischaemic stroke;
- Anticoagulants, which prevent further blood clots from forming. They are also known as 'blood thinners', and;
- Aspirin, which prevents further blood clotting.
Meanwhile, treatment of ischaemic stroke must also focus on stabilizing the patient's condition - mainly taking care of their blood pressure and their breathing status.
In some cases, a blood clot can also be removed surgically - by carotid endarterectomy or cerebral angioplasty.
Carotid arteries are the two main arteries in the neck that supply the brain with blood. If they are clogged, carotid endarterectomy can be tried. An incision is made in the neck and the internal lining of the artery that contains the plaque is removed.
Cerebral angioplasty is also known as stenting. Angiography is used to direct a thin catheter to the blood clot, where a collapsible wire basket is used to then extract the blood clot. A balloon is then used to dilate the blood vessel, before a small cylinder, called a stent, is left in the blood vessel to keep blood flowing to the brain.
After the cause of stroke has been successfully treated, the rehabilitation stage can begin. Its general goals are to restore the person to normal function if possible and to prevent complications. The character, length, intensity and outcome of this stage are different for every person.
For more information on stroke rehabilitation, see our stroke page.
- Broderick, J.P., Palesch, Y.Y., Demchuk, A.M., et al. (2013). Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke. New England Journal of Medicine 368: 893–903.
- (Victoria) D. of H. Stroke. Accessed 5 August 2014 from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/ct_stroke
- Broderick J.P. Palesch Y.Y. Demchuk A.M. et al. (2013). Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke. New England Journal of Medicine 368: 893–903.
- Ciccone A. Valvassori L. Nichelatti M. et al. (2013). Endovascular Treatment for Acute Ischemic Stroke. New England Journal of Medicine 368: 904–913.
- Ding D. (2014). Intravenous Versus Intra-arterial Thrombolysis for Acute Ischemic Stroke Secondary to Basilar Artery Occlusion. Journal of Cerebrovascular and Endovascular Neurosurgery 16: 39–41.
- Donnan G.A. Fisher M. Macleod M. et al. (2008). Stroke. The Lancet 371: 1612–1623.
- Gibson C.L. (2013). Cerebral ischemic stroke: is gender important? Journal of Cerebral Blood Flow & Metabolism 33: 1355–1361.
- Grip O. Kuoppala M. Acosta S. et al. (2014). Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion. British Journal of Surgery 101: 1105–1112.
- Hackett M.L. Köhler S. O’Brien J.T. et al. (2014). Neuropsychiatric outcomes of stroke. The Lancet Neurology 13: 525–534.
- Hemorrhagic stroke treatment. Accessed 5 August 2014 from http://www.uptodate.com/contents/hemorrhagic-stroke-treatment-beyond-the-basics?source=search_result&search=stroke&selectedTitle=3%7E99
- Ischemic stroke treatment. Accessed 5 August 2014 from http://www.uptodate.com/contents/ischemic-stroke-treatment-beyond-the-basics?source=search_result&search=stroke&selectedTitle=2%7E99
- Kidwell C.S. Jahan R. Gornbein J. et al. (2013). A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke. New England Journal of Medicine 368: 914–923.
- Langhorne P. Bernhardt J. & Kwakkel G. (2011). Stroke rehabilitation. The Lancet 377: 1693–1702.
- NIHSeniorHealth: Stroke - About Stroke. Accessed 5 August 2014 from http://nihseniorhealth.gov/stroke/aboutstroke/01.html
- NINDS Know Stroke Campaign - Know Stroke Home. Accessed 5 August 2014 from http://stroke.nih.gov/
- O’Donnell M.J. Xavier D. Liu L. et al. (2010). Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. The Lancet 376: 112–123.
- Stroke. Better Health Channel. Accessed 5 August 2014 from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Stroke
- Stroke Information | cdc.gov. Accessed 5 August 2014 from http://www.cdc.gov/stroke/
- Stroke Information Page: National Institute of Neurological Disorders and Stroke (NINDS). Accessed 5 August 2014 from http://www.ninds.nih.gov/disorders/stroke/stroke.htm
- Stroke symptoms and diagnosis. Accessed 5 August 2014 from http://www.uptodate.com/contents/stroke-symptoms-and-diagnosis-beyond-the-basics?source=search_result&search=stroke&selectedTitle=1%7E99
- Transient ischemic attack. Accessed 5 August 2014 from http://www.uptodate.com/contents/transient-ischemic-attack-beyond-the-basics?source=search_result&search=stroke&selectedTitle=4%7E99
- Van der Worp H.B. & van Gijn J. (2007). Acute Ischemic Stroke. New England Journal of Medicine 357: 572–579.
- What Is a Stroke? - NHLBI NIH. Accessed 5 August 2014 from http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/
- WHO | Stroke Cerebrovascular accident. WHO. Accessed 5 August 2014 from http://www.who.int/topics/cerebrovascular_accident/en/