Stroke Treatment - Interventions

The latest stroke treatment involves advanced surgical techniques. These proceduries have the potential to reverse the effects of stroke, significantly reduce permanent disability from stroke and lead to an optimal recovery. However, to even have a chance, they must be performed within the first few hours after the onset of stroke symptoms.

In general, the goals of surgery are to:

• Prevent further damage to the brain
• Eliminate the root cause of the brain attack
• Restore the brain to normal function
• Prevent future strokes from occurring.

Neuroprotective agents (such as magnesium) may limit acute injury to neurons in the ischemic penumbra following stroke. Surgery can be used for stroke prevention, acute stroke treatment, or for repair of vascular damage or malformations in and around the brain.

Carotid endarterectomy and extracranial /intracranial (EC/IC) bypass are two prominent surgeries for stroke prevention and stroke treatment. Surgical interventions for stroke treatment also include angioplasty and stenting, and the use of endovascular devices to promote thrombolysis, and grabbing and removing clots with tiny clot retrieving devices, breaking up clots with wires and implanting stents to restore blood flow.

Carotid endarterectomy

Carotid endarterectomy is a surgical procedure in which fatty deposits are removed from the inside of one of the carotid arteries. These arteries are located in the neck and are the main suppliers of blood to the brain.

This procedure is used in patients at high risk for thrombotic ischemic strokes, which are caused by blockage in the internal carotid artery. It is also sometimes used after a stroke. In such cases, patients have reported improvements in vision, speech, swallowing, functioning of arms and legs, and general quality of life.

Carotid angioplasty and stenting

Carotid angioplasty is being investigated as an alternative to carotid endarterectomy. It is based on the same principles as angiography done for heart disease.

It is nowadays being used in some centers as an alternative to endarterectomy in patients who cannot undergo endarterectomy, especially for patients with severe stenosis (blockage greater than 70%). However, a 2002 study reported that complications from stents were equal to or less than those of endarterectomy.

EC/IC bypass surgery

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.

A clinical study sponsored by NIH showed that, in the long run, EC/IC does not seem to prevent recurrent strokes in stroke patients with atherosclerosis. The surgery is still performed occasionally for patients with aneurysms, some types of small artery disease, and certain vascular abnormalities.

Clipping

One useful surgical procedure for stroke treatment of brain aneurysms that cause subarachnoid hemorrhage is a technique called "clipping." Clipping involves clamping off the aneurysm from the blood vessel, which reduces the chance that it will burst and bleed.

Detachable coil technique

A new stroke treatment that is gaining wide attention is the detachable coil technique for the treatment of high-risk intracranial aneurysms. A small platinum coil is inserted through an artery in the thigh and threaded through the arteries to the site of the aneurysm. The coil is then released into the aneurysm, where it evokes an immune response from the body. The body produces a blood clot inside the aneurysm, strengthening the artery walls and reducing the risk of rupture. Once the aneurysm is stabilized, a neurosurgeon can clip the aneurysm with less risk of hemorrhage and death to the patient.