Ischaemic stroke

Stroke Helpline: 0303 3033 100

or email: [email protected]

This guide is about strokes due to a blockage in the blood

supply to the brain, also known as ischaemic stroke.

What is an ischaemic stroke? Turn to page 3 to find out how an ischaemic

stroke is diagnosed and treated.
An ischaemic stroke happens when a
blockage cuts off the blood supply to part The effects of your stroke depend on where
of your brain, killing brain cells. Damage to the stroke was in your brain, and the amount
brain cells can affect how the body works. It of damage. For more information, see
can also change how you think and feel. ‘Effects of stroke’ later in this guide. You
can also find comprehensive information
It’s the most common type of stroke, about all the effects of stroke at
and around 85% of strokes in the UK are stroke.org.uk/effects-of-stroke.
ischaemic strokes. The other 15% of strokes
are due to bleeding in or around the brain,
known as haemorrhagic stroke. What causes an ischaemic stroke?
A transient ischaemic attack (TIA or mini- There are a number of reasons why blockages
stroke) is the same as a stroke but the can form and cause an ischaemic stroke.
symptoms only last for a short amount of
time. It is a major warning sign of a stroke Atherosclerosis (narrowed arteries)
and should always be taken seriously. For Atherosclerosis is where fatty deposits
more information about the signs of stroke build up on the inside walls of the blood
and TIA turn to ‘Spotting the signs of stroke’ vessels carrying blood away from the heart
near the end of this guide. (arteries). These deposits are called plaques
or atheromas.
What happens when you have an
ischaemic stroke? Atheromas can build up in the large arteries
If you have an ischaemic stroke, you will be in your neck leading to the brain, making
given specialist care and treatment, including them narrower and stiffer. Atheromas can
medication to reduce your risk of another break down or become inflamed. When this
stroke. Afterwards, you will have support for happens a clot forms around the atheroma,
your recovery including medical treatment which can block the blood vessel. It may
and rehabilitation therapy. break off and move through the bloodstream
into the brain, causing a stroke.

For more information visit stroke.org.uk 1

Ischaemic stroke

What causes atherosclerosis? AF often has no symptoms, but it can cause

Some things can make you more likely to palpitations (feeling as if your heart is racing
have a build-up of fatty materials in your or skipping a beat). For more information
blood vessels. These include: about symptoms and diagnosing AF visit
• Medical conditions including high blood stroke.org.uk/atrial-fibrillation.
pressure, high cholesterol and diabetes.
• Lifestyle factors such as smoking and Patent foramen ovale (PFO, or hole in the
being overweight. heart)
All babies in the womb have an opening
After a stroke, you should get advice about between the right and left side of their heart,
treating your medical conditions, and known as the ‘foramen ovale’. This gap is
making healthy lifestyle changes. For more needed while the baby is connected to the
information about things you can do to stay mother’s blood supply. After birth, the baby’s
healthy after a stroke, visit blood circulation changes, and this gap
stroke.org.uk/reduce-your-risk. usually closes up.

Small vessel disease However, in as many as one in four people,

Small vessel disease means having damage the gap stays open. This is known as a
to the tiny blood vessels deep inside the ‘patent’ (open) foramen ovale, or PFO. It’s
brain. The blood vessels become narrowed sometimes referred to as a ‘hole in the heart’.
which reduces blood flow, and makes a
stroke more likely. It can also lead to many A PFO may be a risk for stroke if a blood clot
small strokes, as well as increasing the risk of forms in the heart and travels up to the brain.
bleeding in the brain. PFO does not always cause problems, and
may not need to be treated.
Small vessel disease can be diagnosed on
a brain scan, where it looks like scars in the In children, surgery is sometimes be used to
brain structure. It can affect your thinking close the PFO. If you have a stroke, you will
ability and your mood, and it’s linked to be assessed to decide if a PFO could have
cognitive decline and dementia. been a reason for your stroke, and what
treatment you need. Treatment options
What causes small vessel disease? include blood thinning medication to reduce
High blood pressure is a common cause of the risk of clots, or surgery to close the PFO.
small vessel disease. If you have high blood Your doctor will talk to you about the best
pressure, you will be offered treatment and treatment for you.
advice for healthy lifestyle changes you can
make to reduce your blood pressure. Read
more at stroke.org.uk/high-blood-pressure.

Heart conditions

Atrial fibrillation (irregular heartbeat)

Atrial fibrillation (AF) means your heartbeat is
irregular and may be abnormally fast. Because
the heart doesn’t empty itself of blood at
each heartbeat, a clot can form in the blood
left behind. If this clot travels through the
bloodstream to the brain, it causes a stroke.

2 Call the Stroke Helpline on 0303 3033 100

 Ischaemic stroke

Other heart conditions Brain scan

Other heart problems, such as a recent heart If you have a suspected stroke, a brain
attack or a mechanical heart valve, can also scan should be carried out urgently, and if
make a stroke more likely. possible within one hour. A brain scan can
help doctors decide if you are suitable for an
Arterial dissection (damage to the artery) emergency treatment such as clot-busting
Arterial dissection is when the lining of an treatment (thrombolysis) and mechanical
artery (a blood vessel leading away from the clot removal (thrombectomy).
heart) gets torn. It can happen after an injury,
but it can also happen with no obvious cause. A computed tomography (CT) scan or a
Blood builds up in the damaged area, and a magnetic resonance imaging (MRI) scan
clot can form. If this clot restricts the flow of is used to produce pictures of your brain.
blood to your brain, or moves up into your Doctors use scans to rule out other causes of
brain, it can cause a stroke. your symptoms, and see how much of your
brain has been affected. It also helps them
Other causes decide how best to treat you, as treatments
Sometimes stroke can be associated with are different depending on the cause and
other health conditions such as inherited timing of your stroke.
blood clotting disorders or heart infections.
Your medical team will investigate these too. Some types of scan involve an injection to
highlight the blood vessels of the neck and
brain more clearly, known as computed
How is an ischaemic stroke tomography angiography (CTA) or magnetic
diagnosed? resonance angiography (MRA).

Other checks and tests

If someone has any signs of a stroke, it’s time Your blood pressure is checked, and you have
to call 999 immediately. Turn to page 9 to blood tests for health conditions linked to
find out more about the signs of stroke. stroke, such as diabetes and high cholesterol.

Ambulance paramedics are trained in stroke. You may have other tests to check for
They assess the person and take them to conditions that could have contributed
the right type of hospital for the treatment to your stroke. These include an
they need. This could be a hospital with a electrocardiogram (ECG), which checks for an
specialist stroke unit or a hyper-acute stroke irregular heartbeat, or a Doppler ultrasound
unit. A stroke unit has an inter-disciplinary scan to check for narrowing of the blood
team of trained professionals who are vessels in your neck.
experienced in stroke care.

The important thing when a stroke happens

is time. The faster someone can get to a
specialist stroke unit, the better their chances
of reducing damage to the brain.

Once you’re admitted to hospital, you have

tests and checks to confirm if you have had a
stroke, and what type of stroke it is.

For more information visit stroke.org.uk 3

Ischaemic stroke

How is an ischaemic stroke To have thrombolysis, the person needs

treated? to reach hospital within the time limits for
treatment (usually four and a half hours after
symptoms begin). If they don’t know when
The main treatments aiming to break up or symptoms began, perhaps because the
remove clots from the brain are usually only stroke happened while they were asleep, this
available within a few hours of a stroke. But may rule out thrombolysis.
there is also a range of other types of care,
including medication to reduce your blood Other reasons why thrombolysis can’t be
pressure and reduce your risk of another given include:
stroke. You will be monitored for signs of
complications and given any treatment you • Your stroke was due to bleeding in the
need. You will be assessed to find out how brain, not a clot.
the stroke has affected you, and what help • Your stroke is very mild.
you need with your recovery. • You have a bleeding disorder.
• You have recently had brain surgery.
• You have had another stroke or head injury
Treatments to break up or within the past three months.
remove clots • Your current medication is not compatible
with the clot-busting medication (alteplase).

The two ways of treating clots in the If you are able to have thrombolysis, your
brain are: medical team will explain the treatment to
you. You do not have to sign any paperwork
• Thrombolysis (clot-busting medication) – a verbal agreement is enough. If you
• Thrombectomy (mechanical clot removal) are unable to give your consent, either
because of the effects of your stroke or
Thrombolysis (clot-busting treatment) another reason, the medical team will seek
Thrombolysis uses a clot-busting medicine to permission from your next of kin or another
break up clots in the brain. This helps to save family member.
more of the brain by allowing blood to return
to the brain cells more quickly. Fewer brain Time is critical so if it isn’t immediately
cells die, and the impact of the stroke can be possible to talk to your family, the medical
reduced. staff will make the decision based on what
they feel is in your best interests.
Thrombolysis needs to be given within four
and a half hours of stroke symptoms starting. How it works
In some circumstances doctors may decide Thrombolysis uses a drug called alteplase,
that it could still be of benefit beyond four or recombinant tissue plasminogen activator
and a half hours. (rt-PA). You are given alteplase through a
small tube into a vein in your arm. During this
Who can have thrombolysis? procedure, which takes around one hour, the
This treatment is only suitable in around 12% medical team will closely monitor your blood
of strokes, as there are guidelines for who pressure, body temperature, breathing and
can and can’t have it, to make sure it’s safe blood sugar levels to ensure that they remain
and effective. stable.

4 Call the Stroke Helpline on 0303 3033 100

 Ischaemic stroke

Risks of thrombolysis Without removal or clot-busting treatment,

Despite its benefits, there is a risk that the blood clot usually breaks up naturally
thrombolysis can cause bleeding in the brain. within a few days or weeks. You are assessed
Within seven days of having thrombolysis, to find out how the stroke is affecting
about one in 25 people treated will have you. You will be supported to recover by
bleeding in the brain, and this can be fatal in specialist doctors, nurses and therapists
about one in 40 cases. working in a team to give you expert care.
You will also be given treatments to reduce
Doctors carefully balance the risk to the your risk of another stroke, such as blood-
patient against the potential benefit of the thinning medications and pills for high blood
treatment. So someone may not be eligible pressure.
for thrombolysis if they have conditions like
internal bleeding or head injury, an aneurysm Surgery: decompressive hemicraniectomy
or uncontrolled high blood pressure. When the brain is injured the tissues can
swell, just like a bruise. If there is a lot of
Thrombectomy (clot removal) swelling, it can put pressure on other areas of
Thrombectomy involves pulling the blood your brain, causing further damage.
clot out of your brain using a clot retrieval
device. This is done by inserting a wire into In a very small number of cases an operation
a blood vessel in your groin, moving it up to may be needed to relieve pressure on your
your brain, and pulling the blood clot out. brain. A decompressive hemicraniectomy
involves opening up a section of your skull to
Like thrombolysis, thrombectomy can help allow the brain to swell outwards and relieve
reduce brain damage by restoring blood flow some of the pressure.
in the brain. This means that fewer brain cells
die, lowering the chance of serious disability.
Treatments to reduce the risk of
This procedure can be given to around 10% of another stroke
people with ischaemic stroke. It is only used
when the clot is in a large blood vessel in
the brain. It should be carried out as soon as Medication
possible after the stroke and within six hours Most people who have an ischaemic stroke will
at the latest. However it can be done up to be given blood–thinning medication to help
24 hours after the stroke, if doctors think prevent clots from forming. For most people
it will benefit the person. It’s often used in this will be a daily dose of aspirin followed
combination with thrombolysis (clot-busting by clopidogrel. If you receive thrombolysis,
medication). you normally have to wait at least 24 hours
before you can begin taking aspirin.
What happens if the clot is not treated?
Clot removal and clot-busting treatment are How long will I need to take blood
effective at reducing disability after stroke, thinning medication?
but only around 10-15% of people are able Most people will need to take blood-thinning
to have them. These treatments are given medication for life. There are two main
on top of the standard stroke care, which types of blood-thinning medication, known
includes tests, medication and therapy. as antiplatelets and anticoagulants. Many
people need antiplatelets such as aspirin and
clopidogrel.

For more information visit stroke.org.uk 5

Ischaemic stroke

People with heart conditions like atrial After 24 hours, you will be supported to get
fibrillation are more likely to have an up, or walk around if it is safe for you to do so.
anticoagulant such apixaban, dabigatran, If you’re not able to move about very much,
edoxaban, rivaroxaban or warfarin. Find out the way you are positioned is very important
more about blood-thinning medications at to help you avoid problems with breathing,
stroke.org.uk/blood-thinning. chest infections (pneumonia), shoulder pain
or pressure sores. The members of your
Surgery for narrowed arteries in the neck stroke team should work with you to find the
(carotid artery disease) best position for you to sit or lie down, and
Around 15% of ischaemic strokes are due help you to move at regular intervals.
to narrowed arteries in the neck, known as
carotid artery disease. This is diagnosed As soon as you are well enough, your doctor
using specialist ultrasound scans of should talk to you about what may have
your neck. Carotid artery disease is due caused your stroke and things you can do to
to atherosclerosis, the build-up of fatty reduce the risk of it happening again. This
materials in your arteries. could mean taking medication, or making
changes to your lifestyle, or both.
Carotid artery disease is sometimes treated
using a surgical procedure. This means either
removing the artery lining, or inserting a
mesh cylinder (stent) to keep the artery
open. You’ll be assessed to decide on the
best treatment to help reduce your risk of
a stroke, which might include medication
instead of surgery.

For more information, read our guide

‘Carotid artery disease’ or visit
stroke.org.uk/carotid-artery-disease.

Your care in the first 24 hours after a stroke

The team on the stroke unit continue to
monitor you closely for at least 24 hours to
ensure you remain stable. You should have a
swallowing test within four hours of being in
hospital, to make sure it’s safe for you to eat
and drink, or take medicine by mouth.

You may see some signs of recovery from

your stroke early on, but if you’re still
showing lasting effects after 24 hours, you
will have a full assessment with all the
professionals on the stroke team. The team
can include physiotherapist, speech and
language therapist, occupational therapist,
dietitian, orthoptist and a psychologist.

6 Call the Stroke Helpline on 0303 3033 100

 Ischaemic stroke

What effects can a stroke have? Rehabilitation

You should receive rehabilitation soon
The effects of stroke depend on the size and after your stroke. It may begin in hospital
location of the damaged area in your brain. and should carry on at home if you need
For some people the effects of a stroke may it. Rehabilitation is part of your recovery. It
be relatively minor and may not last long, means trying to restore function to as near
while others may be left with long-term normal as possible, and helping you adapt to
effects or a disability. disability.

The effects of stroke include: During rehabilitation, the therapist assesses

you and designs treatment tailored to your
• Movement and balance problems needs. Depending on the type of therapy,
• Communication problems you may have exercises to practise. You may
• Problems with memory, concentration work towards building up stamina, or learn
and thinking (cognition). new ways of doing things.
• Problems with vision.
• Problems with swallowing. Neuroplasticity
• Continence problems. Although brain cells that have been severely
• Fatigue. damaged or have died can’t grow back,
the brain can re-wire itself, allowing you
You can read more about all the effects to relearn things like walking, speech and
of stroke in our guide ‘Next steps after swallowing. This is called neuroplasticity.
a stroke’ or visit Neuroplasticity is the process that happens in
stroke.org.uk/effects-of-stroke. the brain when you do rehabilitation therapy.
By repeating the therapy activities, your brain
Emotional changes starts to form new connections, allowing you
Stroke can have a powerful emotional effect to improve.
on you and the people around you. Many
people have emotional changes after a
stroke, including anxiety and depression. 1. Signals go from one cell
A stroke can change how people see to another, forming a
themselves. Stroke usually comes as a big connection in the brain.
shock, and many people say they have lost
some of their confidence.

Help is available with emotional problems,

so if you feel low or anxious, or think you 2. When a stroke kills brain
may be depressed, visit your GP. cells, it damages the
connection.
Will I be able to make a full recovery?
Everyone recovers differently. Some people
recover fully. Other people will have health
problems or a disability. The fastest recovery
takes place in the first few months. After 3. Brain cells can
that progress can be slower, but people can sometimes form new
continue to improve for months or years connections, and start
after a stroke. sending signals again.

For more information visit stroke.org.uk 7

Ischaemic stroke

Support after leaving hospital • For more information about support and
life after stroke including accommodation,
When you are able to leave hospital, the money and benefits, and information for
discharge process should ensure that you get carers, visit stroke.org.uk.
all the support you need. You and your family
will be involved in planning your discharge.
The discharge plan covers: Will I have another stroke?
• Rehabilitation. One of the biggest worries for many people
• Medical treatment. is whether they will have another stroke. This
• Care at home. can be part of the emotional impact of stroke
• Equipment you may need. on you, your family and friends. But it can
• Follow-up. help to know that when you have a stroke,
one of the main aims of your hospital team is
Early supported discharge to stop you having another stroke.
Some people can leave hospital soon after a
stroke and have their treatment and therapy Brain scans and other test and checks find
at home. You need to be able to move from out what caused your stroke and allow
a bed to a chair, and have a safe home doctors to target your treatment. After an
environment to go to. ischaemic stroke, you will be given medicine
to avoid blood clots forming. If you have
Post-stroke review a health condition linked to stroke such as
Around six months after you leave hospital, high blood pressure, you will be given any
you should get a review of your progress. treatment and advice that you need to help
This makes sure you are getting the right you avoid another stroke.
support if your needs have changed,
including rehabilitation. The review is Having a stroke or TIA means that you are
sometimes carried out by a stroke specialist at greater risk of having another stroke. The
nurse or other stroke professional. In some risk is highest in the days and weeks after a
areas, you may see a Stroke Association stroke, which is why doctors work so hard to
Coordinator. If a review does not take place, reduce your risk early on.
contact your GP.
In the months and years after a stroke,
Who will support me? you could help to keep your risks low by
following the treatments for your health
• Your GP coordinates your care after conditions, and making healthy lifestyle
leaving hospital, and can help with your changes.
medical problems or support needs.
• You might need support from therapists, When you have a stroke, doctors check you
such as physiotherapists, occupational for any health conditions linked to stroke.
therapists, speech and language therapists These health conditions include:
and psychologists.
• You might have a community stroke nurse. • High blood pressure.
• You may have a social worker. • Atrial fibrillation (irregular heartbeat).
• Depending on where you live, you may • Diabetes.
have help from a Stroke Association • High cholesterol.
Coordinator.

8 Call the Stroke Helpline on 0303 3033 100

 Ischaemic stroke

One of the best ways to reduce your risk The FAST test identifies the main signs of a
is to carry on with any treatment you are stroke. But there are also some others to look
given. If you have any questions about your out for:
medication, speak to your GP or pharmacist.
Never stop taking your medication without • Sudden weakness or numbness on one
talking to your GP first. side, including legs, hands or feet.
• Difficulty finding words or speaking in
You should also be given advice about other clear sentences.
ways of reducing your risk of a stroke. Some • Sudden blurred vision or loss of sight in
people need to lose weight, be more active, one or both eyes.
give up smoking or drink less alcohol. • Sudden memory loss or confusion, and
dizziness or a sudden fall.
Ask your GP what you can do to reduce • A sudden, severe headache.
your risk of another stroke. Read our
guide ‘How to reduce your risk of a stroke’ If you spot any of these signs, call 999
or visit stroke.org.uk/reduce-your-risk. straight away.

A transient ischaemic attack (TIA or mini-

Spotting the signs of a stroke stroke) is the same as a stroke, except
that the symptoms last for a short amount
The FAST test can help you to recognise of time. A TIA is serious and should not
the symptoms of a stroke. These symptoms be ignored. If you experience any of the
usually come on suddenly. symptoms described above, call 999.

FAST test
Driving
Face
Can the person smile? By law, you must not drive for a month
Has their face fallen on after a stroke or TIA. You might need
one side? to tell the DVLA (or DVA if you are in
Northern Ireland) about your stroke.
Arms Depending what kind of stroke you had
Can the person raise both and the kind of driving licence you hold,
arms and keep them there? you might not be able to drive for a longer
period or may have to stop driving.
Speech To find out what you should do, read our
Can the person speak clearly guide ‘Driving after stroke’ or visit
and understand what you say? stroke.org.uk/driving.
Is their speech slurred?

Time
If you see any of these three
signs, it’s time to call 999.

For more information visit stroke.org.uk 9

Ischaemic stroke

Where to get help and Other sources of help and

information information

From the Stroke Association Atrial Fibrillation Association (AFA)

Website: heartrhythmalliance.org/afa/uk
Helpline Tel: 01789 867 502
Our Helpline offers information and support Provides information and support for people
for anyone affected by stroke, including with atrial fibrillation.
family, friends and carers.
Brain and Spine Foundation
Call us on 0303 3033 100, from a Website: brainandspine.org.uk
textphone 18001 0303 3033 100 Helpline: 0808 808 1000
Email [email protected]. Provides information and support to people
affected by neurological conditions including
Read our information stroke. The helpline is run by neuroscience
Get more information about stroke online at nurses.
stroke.org.uk, or call the Helpline to ask for
printed copies of our guides. Chest, Heart and Stroke Scotland
Website: chss.org.uk
My Stroke Guide Helpline: 0808 801 0899
The Stroke Association’s online tool Provides information on local stroke groups
My Stroke Guide gives you free access to in Scotland. It also runs an advice line staffed
trusted advice, information and support 24/7. by nurses.
My Stroke Guide connects you to our online
community, to find out how others manage Different Strokes
their recovery. Website: differentstrokes.co.uk
Tel: 0345 130 7172
Log on to mystrokeguide.com today. Provides information and support for
younger stroke survivors, including guides for
survivors, their family and employers.

Headway
Website: headway.org.uk
Tel: 0808 800 2244
A national charity supporting people with
a brain injury. They have local groups and
branches, which include rehabilitation
programmes, carer support, social activities,
community outreach and respite care.

NHS UK
Website: nhs.uk
Information on health.

10 Call the Stroke Helpline on 0303 3033 100

 Ischaemic stroke

Your notes

For more information visit stroke.org.uk 11

Ischaemic stroke

About our information

We want to provide the best information
for people affected by stroke. That’s why
we ask stroke survivors and their families,
as well as medical experts, to help us put
our publications together.

How did we do?

To tell us what you think of this guide, or
to request a list of the sources we used to
create it, email us at
[email protected].

Accessible formats
Visit our website if you need this
information in audio, large print or braille.

Always get individual advice

This guide contains general information
about stroke. But if you have a problem,
you should get individual advice from a
professional such as a GP or pharmacist.
Our Helpline can also help you find
support. We work very hard to give you
the latest facts, but some things change.
We don’t control the information provided
by other organisations or websites.

© Stroke Association 2022

Version 6. Published May 2022
To be reviewed: April 2024
Item code: A01F35

Every five minutes, stroke destroys lives. We need your support to help
rebuild them. Donate or find out more at stroke.org.uk.

The Stroke Association is registered as a charity in England and Wales (No 211015) and in Scotland (SC037789).
JN 2122-327.6

Also registered in the Isle of Man (No. 945) and Jersey (No. 221), and operating as a charity in Northern Ireland.

12 Call the Stroke Helpline on 0303 3033 100