Treatment
The therapy of a blood clot in the head consists primarily of correcting the circulatory problem caused by the clot. This is primarily done by so-called lysis therapy, in which a drug is introduced into the body’s circulation via the vein, which dissolves blood clots. This drug is called rtPA (recombinant tissue plasminogen activator).
A distinction is made between systemic thrombolysis and local thrombolysis. A limiting criterion for the treatment of a blood clot using lysis therapy is time. Systemic thrombolysis can be applied in a time window of about 4.5 hours after the start of the stroke.
Local thrombolysis, in which a catheter is advanced to the site of the blood clot and a clot-dissolving drug is then administered in close proximity, can be performed up to 6 hours after the stroke. Another therapy option for acute vascular occlusion is mechanical thrombectomy, in which a catheter is inserted via the vascular system and advanced until it reaches the vascular occlusion. Here the blood clot is then removed via the catheter, thereby exposing the vessel and restoring blood flow.
In order to prevent a blood clot from forming again, a so-called secondary prophylaxis is carried out. An important component of this secondary prophylaxis is blood thinning, which is intended to prevent a renewed clumping of blood platelets (thrombocytes). If there are no contraindications for this blood-thinning therapy, it should be carried out for life. The most commonly used medication for this is ASA (Aspirin®), which can be prescribed alone or in combination with other anticoagulant drugs.
When does the blood clot have to be removed surgically?
Surgical removal of a blood clot in the head is only an option for a relatively small proportion of patients. Since it is a complex and complicated operation, experienced specialists and appropriately equipped neurological centres are necessary. A further prerequisite for the operation is the location and accessibility of the blood clot. The further away a clot is from the larger vessels, the more difficult it is to reach and thus cannot be reached surgically.
Long-term consequences
The long-term consequences of a blood clot in the head can vary greatly and depend on the affected area of the brain as well as the duration of the undersupply. In so-called transistoric ischemic attacks, the reduced blood flow in an area of the brain leads to symptoms of failure for a short period of time. These disappear completely within 24 hours without leaving any damage.
The most common consequences after a manifest stroke caused by a blood clot in the head include speech and swallowing disorders. They occur in approx. 70% of all those affected and often persist in the long term.
Another very common consequence is paralysis: for example in the face or on one side of the body (hemiparesis). Attention and memory disorders also remain as a long-term consequence in many affected persons. In addition to symptoms that do not recede after a stroke, other clinical pictures can also occur. For example, epilepsy (convulsions).
