Surgical Procedures for Stroke
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Surgery can be done to bring back blood flow to the brain. It may be done right away if a person had a large stroke. Surgery might not cure the cause of the stroke or fix harm that was done, but it can help to stop more harm.
Surgery Choices During a Stroke
A large stroke can cause brain swelling. If medicine does not help, surgery may be done to ease swelling and stop it from causing more harm to the brain. A flap of bone over the swelling may be temporarily opened to ease pressure.
In a person who has had a hemorrhagic stroke, the blood clot may also be taken out to stop further harm to the brain.
A tube is threaded through the blood vessel until it gets to the clot in the brain. The clot may be taken out through the tube or clot-busting drugs may be given through the tube.
Other devices may be used to take out a clot. Some have a corkscrew tip or a special ring to take clots out. They are put in a tube and guided to the place of the blockage. When the reach the right place, it is used to take out the clot. They can remove the clot in minutes, open blood flow, and lower the amount of harm that can be done.
Surgery to Prevent Another Stroke
Atherosclerosis (fatty buildup) in the arteries in the brain or the arteries that lead to the brain may raise the risk of another stroke. It may cause:
- Narrowing of an artery that will block blood from getting to the brain
- A hardened fatty deposit that could break off and block the artery
Surgery tries to fix this. A person may have:
A narrow part of the artery, often the carotid artery, can be bypassed by sewing in a tube above and below the part that is blocked. The bypass may go around a short, narrowed part of an artery or it may link an artery inside the skull with one outside the skull.
This like an arterial bypass. A temporary bypass needs to be used during it. An endarterectomy carves out the inner lining of the carotid artery. It leaves behind the outer layers to carry the blood. CEA is done more often than arterial bypass for atherosclerotic disease of the arteries.
A tube is guided through the blood vessels and into the carotid artery or, less often, another artery in the brain. A balloon is delivered through the tube and inflated in the blood vessel. This is done to try to widen the blood vessel and help blood flow through it. A mesh tube called a stent is often left in the artery to keep it open. A mesh screen may be put in the artery to catch any bits of plaque or clots that might flow into the brain.
Angioplasty may be a choice for people who would have a high risk of problems from CEA.
Aneurysms are weak spots in arteries that balloon out and may burst. This would let blood flow at high pressure to pump into tissues. It might be able to be repaired before it causes a major hemorrhagic stroke. An enlarging aneurysm may put pressure in the brain before it ruptures. Or, it may leak slowly enough to be spotted and fixed before major bleeding happens.
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The goal is to take out or clip a small weak spot on a blood vessel. When it is in view, a metal clip is clamped around the base of the aneurysm.
There are other ways to do this without surgery. Aneurysms can be treated through blood vessels by guiding long, thin tubes into them. It may be blocked from inside by inserting metal coils or squirting them full of tiny beads or other materials. These will cause a clot to form and scar.
Treating Heart Problems
In many people, stroke may be from heart disease. You may need surgery to fix these causes to lower the risk of another stroke. This may mean:
- —Replacing leaky or faulty heart valves helps the heart to pump blood.
- —A blood clot can form on the valves or in the chambers of the heart. If it does not get smaller with medicine, surgery may be done to take it out.
- —A problem with the heart's structure may cause blood flow to be blocked or have abnormal patterns. Fixing them helps the heart work better and helps blood to flow more easily in the body.
- Stroke. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/stroke. Accessed March 11, 2022.
- Stroke (acute management). EBSCO DynaMed website. Available at: https://www.dynamed.com/management/stroke-acute-management-1. Accessed March 16, 2022.
- Winstein CJ, Stein J, Arena R, et al, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research.. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016 Jun;47(6):e98-e169 full-text, corrections can be found in Stroke 2017 Feb;48(2):e78 and Stroke 2017 Dec;48(12):e369.