Surgery can be used to prevent stroke, to treat acute stroke, or to repair vascular damage or malformations in and around the brain.
Surgical treatment for a stroke depends on whether it is ischemic or hemorrhagic.
Surgical Procedures for Ischemic Stroke & TIA
There are two prominent types of surgery for stroke prevention and treatment: carotid endarterectomy and extracranial/intracranial (EC/IC) bypass.
This is a surgical procedure in which a doctor removes fatty deposits (plaque) from the inside of one of the carotid arteries, which are located in the neck and are the main suppliers of blood to the brain. As mentioned earlier, the disease atherosclerosis is characterized by the buildup of plaque on the inside of large arteries, and the blockage of an artery by this fatty material is called stenosis.
Extracranial/Intracranial (EC/IC) Bypass
EC/IC bypass surgery is a procedure that restores blood flow to a blood-deprived area of brain tissue by rerouting a healthy artery in the scalp to the area of brain tissue affected by a blocked artery.
Surgical Procedures for Hemorrhagic Stroke
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures. The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Unlike ischemic strokes, hemorrhagic strokes aren’t treated with antiplatelet medicines and blood thinners because these medicines can make bleeding worse.
If you’re taking antiplatelet medicines or blood thinners and have a hemorrhagic stroke, you’ll be taken off the medicine. If high blood pressure is the cause of bleeding in the brain, your doctor may prescribe medicines to lower your blood pressure. This can help prevent further bleeding.
Surgery also may be needed to treat a hemorrhagic stroke. The types of surgery used include aneurysm clipping, coil embolization, and arteriovenous malformation (AVM) repair.
Aneurysm Clipping and Coil Embolization
If an aneurysm (a balloon-like bulge in an artery) is the cause of a stroke, your doctor may recommend aneurysm clipping or coil embolization.
Aneurysm clipping is done to block off the aneurysm from the blood vessels in the brain. This surgery helps prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again. During the procedure, a surgeon will make an incision (cut) in the brain and place a tiny clamp at the base of the aneurysm. You’ll be given medicine to make you sleep during the surgery. After the surgery, you’ll need to stay in the hospital’s intensive care unit for a few days.
Coil embolization is a less complex procedure for treating an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the site of the aneurysm. Then, a tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from bursting again. Coil embolization is done in a hospital. You’ll be given medicine to make you sleep during the surgery.
Arteriovenous Malformation Repair
If an AVM is the cause of a stroke, your doctor may recommend an AVM repair. (An AVM is a tangle of faulty arteries and veins that can rupture within the brain.) AVM repair helps prevent further bleeding in the brain.
Doctors use several methods to repair AVMs. These methods include:
- Injecting a substance into the blood vessels of the AVM to block blood flow
- Surgery to remove the AVM
- Using radiation to shrink the blood vessels of the AVM
Reference: The National Institute of Neurological Disorders and Stroke