Thrombotic Stroke

What is a thrombotic stroke?

A thrombotic stroke is a stroke that happens when a blood clot forms in a blood vessel in your brain and blocks it.

Any stroke caused by a blockage like a clot is an ischemic stroke. A thrombotic stroke is a specific subtype.

Like all strokes, thrombotic strokes are life-threatening medical emergencies and can be fatal. If you think you or someone you’re with is having a stroke, immediately call 911 or your local emergency services number. The sooner someone is diagnosed and treated, the more likely it is they’ll survive. Every second counts.

What are thrombotic stroke symptoms?

Thrombotic strokes share symptoms with other types of ischemic strokes, including:

• Double vision (diplopia) or blurry vision
• Headaches (usually sudden and severe)
• Loss of muscle control on one side of your face
• New nausea and vomiting
• Passing out or fainting
• Slurred or garbled speaking (dysarthria)
• Sudden loss of any of your senses (including vision, hearing, smell, taste and touch)
• Trouble speaking or a complete loss of speech (aphasia)
• Trouble walking or balance issues (an unsteady gait)
• Unresponsiveness
• Weakness or paralysis on one side of your face and body

What are the warning signs of a thrombotic stroke?

Thrombotic strokes can cause lots of different symptoms. To recognize the warning signs of a stroke in yourself or a loved one, remember the acronym BE FAST:

• Balance. Watch for a sudden loss of balance.
• Eyes. Look out for sudden vision loss or changes in one or both eyes.
• Face. Smile. Look for a droop on one or both sides of your or someone else’s face.
• Arms. Raise both arms. If you or someone is having a stroke, one arm will sag or drop in a way that it usually doesn’t.
• Speech. You might slur your speech or have trouble choosing the right words.
• Time. Time is critical — call for help immediately. If possible, look at your watch, phone or a clock to track when symptoms start. Telling a healthcare provider when symptoms began can help them know which treatment options are best for you.

What causes thrombotic strokes?

Thrombotic strokes happen when something blocks a blood vessel in or near your brain.

“Thrombus” is the medical name for a clot, and thrombosis is the process that forms them. So, a thrombotic stroke is a stroke caused by a thrombus.

Many health conditions can lead to thrombosis, including:

• Atherosclerosis (hardened arteries)
• Atrial fibrillation
• Clotting disorders
• COVID-19
• High blood pressure (hypertension)
• High cholesterol (hyperlipidemia)
• Infections (including bacterial or fungal infections, bloodstream infections, sepsis and heart valve infections)

Transient ischemic attacks

A transient ischemic attack (TIA) — sometimes called a “mini-stroke” — is like a stroke, but the symptoms are temporary and usually last less than 24 hours. TIA symptoms are the same as stroke symptoms. A TIA is a warning sign that a person has a very high risk of having a true stroke soon. A person who has a TIA needs emergency medical care as soon as possible.

Thrombotic stroke risk factors

Anyone can have a thrombotic stroke, but some groups have a higher risk, including people who:

• Are Black
• Are older than 65
• Smoke or use other forms of tobacco or nicotine (like vaping)
• Use recreational or nonprescription drugs

Having certain health conditions can increase your risk, including:

• Alcohol use disorder
• High blood pressure (hypertension)
• Diabetes

How are thrombotic strokes diagnosed?

A healthcare provider will diagnose a thrombotic stroke with a neurological exam, a physical exam and other tests. Providers in the emergency room may diagnose it if emergency services transport you to the ER.

Your provider will use some of the following tests to confirm that you’ve had a stroke:

• Blood tests
• Carotid ultrasound
• CT scan and/or CT angiogram
• Echocardiogram
• MRI and/or MRI angiogram

What are thrombotic stroke treatments?

The most important part of treating a thrombotic stroke is restoring blood flow to your brain. Healthcare providers will try to do this as fast as possible to reduce your risk of permanent brain damage, new disabilities and death.

The two most common treatments include:

• Mechanical thrombectomy. This is a procedure to remove a blood clot with a small, thin tube (a catheter). A healthcare provider will insert a catheter into a blood vessel in your wrist or groin. Then, they’ll thread the catheter up to the clot in your brain. They’ll either vacuum the clot up in one piece or break it apart and suck up the pieces. Thrombectomy can be performed within 24 hours of when you start having symptoms.
• Thrombolytic therapy. These are medications that dissolve clots. Providers will only use them if it’s been less than four and a half hours since you started having stroke symptoms.

You may need other treatments, including:

• Blood sugar management. Your providers will monitor your blood glucose (blood sugar) levels to help your brain recover.
• Blood thinners. It’s common to need aspirin or other antiplatelet medications. Anticoagulant medications are stronger medications that can lower your stroke risk if you have atrial fibrillation or a clotting disorder.
• Endarterectomy. This is surgery to remove plaque from narrowed or blocked arteries. This can reduce the risk you having another blood clot.
• Mild intentional hypothermia. Your providers might safely lower your body temperature. This can slow down brain damage during and after a stroke.
• Oxygen therapy. Your brain doesn’t get enough oxygen during a stroke. Your providers may have you wear a nosepiece that gives you extra oxygen. This will make it easier to breathe and help your body restore oxygen to your brain.
• Stenting. A stent is a tiny tube that helps keep a blood vessel open and increase blood flow.

Thrombotic stroke rehabilitation

Stroke rehab is an important part of treating a thrombotic stroke. You’ll need stroke rehab to help you adjust to changes in your brain and body after a stroke. You may need to regain abilities you had before or adjust to new or different disabilities. You might need a combination of:

• Cognitive rehab to help improve your memory, concentration and other mental abilities.
• Occupational therapy to help you safely complete your daily tasks, especially chores or activities that need precise body movements.
• Physical therapy to strengthen your muscles, improve your balance and regain use of your arms and legs.
• Speech therapy to regain or improve your language and speaking abilities and control the muscles that help you talk, breathe, eat and swallow.

Can you prevent a thrombotic stroke?

Maintaining your overall health is the best way to prevent thrombotic strokes and the blood clots that cause them. Try to:

• Eat plenty of healthy foods and maintain a weight that’s healthy for you.
• Get regular physical activity.
• Manage your cholesterol, blood pressure and any health conditions you have.
• Quit smoking.

Visit a healthcare provider for a check-up every year (or as often as they suggest). Many of the health conditions and issues that can cause thrombotic strokes develop or build up over time. They may not cause symptoms you can feel or notice. Your provider will help you catch and manage any warning signs before they increase your risk of a stroke later on.

What is the survival rate for thrombotic strokes?

Stroke survival rates continue to increase as we develop better, faster ways to treat them. But there’s no one set recovery timeline or outlook that’s accurate for everyone.

Thrombotic strokes (and other types of ischemic strokes) tend to have better survival rates than hemorrhagic strokes. But that doesn’t mean you’re more or less likely to survive than anyone else. Everyone’s health and body respond differently to a stroke, so it’s hard for experts to estimate accurate guesses that apply to everyone.

Thrombotic stroke prognosis

What you can expect depends on a few factors, including:

• How quickly it was treated
• Which areas of your brain it affected
• Your overall health

Most people take a few months to recover. Your provider will tell you what to expect. They’ll help you set recovery goals and expectations that fit your unique health and situation.

How do I take care of myself after a thrombotic stroke?

Recovering and rehabbing after a stroke is hard work. Once you and your provider finalize your treatment plan, follow it as closely as possible. In general, you should:

• Go to your rehab and other therapy appointments. Tell your therapists if anything makes you feel unsafe or uncomfortable. Rehab is hard work, but you shouldn’t be in constant pain or discomfort.
• Remember your mental health. Depression and anxiety are extremely common after a stroke. Your emotional health can be just as important as how your physical body is doing. You’re not weak or a quitter for feeling sad or upset. Talk to your provider or a mental health professional if you feel like you need help processing anything during your recovery.
• Take your medications. This is especially true while you’re taking blood thinners. Reducing the risk of future blood clots is important, and taking your medicine as often as your provider suggests will help your body heal.

When should I go to the ER?

Call 911 (or your local emergency services number) if you think you’re experiencing stroke symptoms again. Another stroke has an even higher risk of causing severe complications and being fatal. Don’t wait to call for help or go to the emergency room.

People who’ve had a thrombotic stroke have an increased risk of other potentially serious complications, including:

• Deep vein thrombosis (DVT)
• Heart attack
• Pulmonary embolism
• Pneumonia
• Seizures

Call emergency services or go to the ER if you think you’re experiencing any symptoms of these complications.

Which questions should I ask my healthcare provider?

• Which changes to my daily routine will I need to make?
• Which condition or issue caused it?
• Where in my brain did the blood clot form?
• Which medications will I need, and how do I take them?