Stroke Surgery: When And Why?

do you get surgrey when someone has a stroke

Strokes are a medical emergency that require immediate treatment to lessen brain damage and prevent death. The type of treatment depends on the type of stroke. The most common type of stroke is ischemic stroke, which occurs when blood vessels that supply the brain become blocked by a clot. Hemorrhagic stroke is another type of stroke, which occurs when there is bleeding in or around the brain. In some cases, strokes can be treated with surgery, which may involve removing or dissolving blood clots, draining fluid from the brain, or relieving pressure or swelling in the brain.

Characteristics Values
When is surgery needed? When there is a blockage in a carotid artery in the neck that supplies blood to the brain.
Types of surgery Carotid Endarterectomy, Aneurysm Clipping, Coil Embolization, Thrombectomy
What happens during a Carotid Endarterectomy? Surgeons make an incision along the side of the neck, locate the carotid artery, open the artery and remove the plaque, then close it.
What is a Thrombectomy? A thrombectomy is surgery to remove a blood clot.
What is a Coil Embolization? A doctor inserts a flexible tube called a catheter into an artery in the groin and threads the catheter to the site of the aneurysm. Then, the doctor pushes a tiny coil through the tube and into the aneurysm, causing a blood clot to form.

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Clot-removing surgery

Thrombectomy is recommended for patients with severe ischemic strokes, which are caused by a clot in an artery that blocks the flow of blood to the brain. This type of stroke is the most common, accounting for up to 85% of all strokes. In an ischemic stroke, unhealthy arteries are one of the main causes, as cholesterol, fat, and other substances can build up and form fatty deposits called plaques in the walls of the arteries. These plaques can break off and cause clots that cut off blood flow, or they can travel through the bloodstream until they reach an artery that is too small for them to pass through.

The decision to perform a thrombectomy is based on imaging tests that assess the blockage in the artery. These tests may include a computerized tomography (CT) scan with contrast dye, a cerebral angiogram, or a carotid (artery) ultrasound. If the artery is more than 50% blocked, surgery may be recommended. However, not everyone is a good candidate for this procedure. Contraindications include serious heart problems, uncontrolled high blood pressure, major illnesses such as kidney failure or lung disease, and severe damage or blockage in other major arteries.

The benefits of clot-removing surgery are significant. Patients who undergo a thrombectomy have significantly less post-stroke disability and improved functional independence compared to those who receive medical management alone. Additionally, there is a lower risk of subsequent neurological worsening due to poor blood flow to the brain.

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Aneurysm clipping

During the procedure, the patient is put under general anaesthesia. The surgeon makes a small incision behind the hairline and creates a "window" in the skull to access the brain. The dura, the protective covering of the brain, is then opened, and the surgeon locates and detaches the aneurysm from surrounding structures. The surgeon then places the clip over the neck of the aneurysm, ensuring that no other vessels are clipped. The clip remains permanently on the artery, and the surgical openings are closed.

The benefits of aneurysm clipping include a reduced chance of aneurysm recurrence, lowering the need for follow-up testing. However, it is an invasive procedure requiring a recovery period of at least four to six weeks.

The decision to perform aneurysm clipping depends on various factors, including the patient's age, the size and location of the aneurysm, and their overall health. In some cases, less invasive endovascular approaches, such as coiling, may be preferred, especially for older patients or those with other health conditions.

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Coil embolization

Endovascular coiling, also known as coil embolization or endovascular embolization, is a procedure used to treat hemorrhagic strokes caused by ruptured or unruptured aneurysms. It is a minimally invasive technique that involves accessing the aneurysm from within the bloodstream. During the procedure, a surgeon guides a catheter through the arterial network until it reaches the site of the aneurysm.

Once the catheter is in place, the surgeon introduces a coil, typically made of platinum, that comes in a variety of shapes, sizes, and coatings that promote clotting. Multiple coils are packed inside the aneurysm to block normal blood flow and form a clot, effectively removing the risk of rupture. Over time, this clot prevents blood from flowing into the aneurysm but allows blood to flow freely through the normal arteries.

While coil embolization offers new hope for hemorrhagic stroke patients, it is not without risks. Complications may include the coils poking through the aneurysm or a blood vessel, loss of consciousness, stroke, paralysis, aphasia, and a higher chance of an aneurysm returning. Patients are advised to discuss any concerns with their healthcare provider before the procedure.

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Carotid endarterectomy

During the procedure, a vascular surgeon makes a small incision on the neck at the site of the blockage. The blood flow is temporarily rerouted or clamped off, and the surgeon opens up the carotid artery, removes the plaque, and stitches it closed. In some cases, a patch may be necessary to widen the vessel lumen. The surgery typically lasts one to two hours.

CEA is recommended for patients with severe carotid artery disease, where the artery is more than 50% blocked. It is particularly beneficial when performed shortly after the onset of stroke symptoms or in asymptomatic patients with severe stenosis. The procedure effectively reduces the risk of stroke and improves overall survival rates.

There are some risks associated with CEA, including the possibility of a stroke or heart attack during the operation, as well as nerve damage affecting the muscles in the mouth, throat, or face. After the procedure, patients typically spend a couple of days in the hospital and may experience soreness, bruising, and swallowing difficulties.

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Thrombectomy

There are two main types of thrombectomy: surgical (open) and percutaneous (minimally invasive). During a surgical thrombectomy, the surgeon makes an incision to access the blocked blood vessel, cuts it open, removes the clot using a balloon, and then repairs the vessel. In a percutaneous thrombectomy, the surgeon uses catheters and special devices to break up, dissolve, or suction out the clot.

The decision to perform a thrombectomy is based on multiple factors, including the location and size of the blood clot, and the patient's overall health. Some patients may not be suitable candidates for thrombectomy if the clot is in a hard-to-reach location, a very small blood vessel, or if they have certain preexisting conditions.

Frequently asked questions

A stroke occurs when blood flow to the brain is interrupted, either due to a blockage or bleeding in or around the brain. This causes brain cells to be deprived of oxygen, leading to damage or death of brain tissue.

The two main types of strokes are ischemic strokes and hemorrhagic strokes. Ischemic strokes are the most common type and occur when blood vessels that supply the brain become blocked, often by a blood clot. Hemorrhagic strokes happen when there is bleeding in or around the brain, which can be caused by a ruptured aneurysm.

Symptoms of a stroke include sudden weakness in the face, arm, or leg on one side of the body, blurred or decreased vision, difficulty speaking or communicating, altered sensation on one side of the body, and poor coordination or walking difficulties. It is important to seek immediate medical attention if you or someone else experiences any of these symptoms.

The treatment for a stroke depends on the type of stroke and can include medications, surgery, or other procedures. Medications such as anticoagulants, blood pressure-lowering drugs, and statins may be prescribed to dissolve blood clots, prevent clot formation, or manage risk factors. Surgery, such as thrombectomy or carotid endarterectomy, may be performed to remove blood clots or address blockages.

Surgery for stroke, such as thrombectomy, is typically performed within a specific timeframe to maximize its effectiveness. In some cases, thrombectomy has been approved for up to six hours after a stroke, and research is ongoing to extend this timeframe.

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