Stroke

Surgery and Vascular Procedures

Surgery and vascular procedures can be used to prevent stroke, to treat stroke, or to repair damage to the blood vessels or malformations in and around the brain.

Surgery

Carotid endarterectomy is a surgical procedure in which a surgeon removes fatty deposits, or plaque, from the inside of one of the carotid arteries. The procedure is performed to prevent stroke. The carotid arteries are located in the neck and are the main suppliers of blood to the brain.

Specialized Catheters Aid Vascular Procedures

In addition to surgery, a variety of techniques have been developed to allow certain vascular problems to be treated from inside the artery using specialized catheters with the goal of improving blood flow. Vascular is a word that refers to blood vessels, arteries, and veins that carry blood throughout the body.

A catheter is a very thin, flexible tube that can be inserted into one of the major arteries of the leg or arm and then directed through the blood vessels to the diseased artery. Physicians trained in this technique called angiography undergo additional training to treat problems in the arteries of the brain or spinal cord. These physicians are called neurointerventionalists.

  • Angioplasty, is widely used by angiographers to open blocked heart arteries, and is also used to prevent stroke. Angioplasty is a procedure in which a special catheter is inserted into the narrowed artery and then a balloon at the tip of the catheter is inflated to open the blocked artery. The procedure improves blood flow to the brain.
  • Another procedure used to prevent stroke is called stenting. In this procedure an angiographer inserts a catheter into the artery in the groin and then positions the tip of the catheter inside the narrowed artery. A stent is a tube-like device made of a mesh-like material that can be slipped into position over the catheter. When positioned inside the narrowed segment the stent is expanded to widen the artery and the catheter is removed. Angioplasty or stenting of the carotid artery can cause pieces of the diseased plaque to loosen. An umbrella-like device is often temporarily expanded above to prevent these pieces from traveling to the brain.
  • Angiographers also sometimes use clot removal devices to treat stroke patients in the very early stage. One device involves threading a catheter through the artery to the site of the blockage and then vacuuming out the clot. Another corkscrew-like device can be extended from the tip of a catheter and used to grab the clot and pull it out. Drugs can also be injected through the catheter directly into the clot to help dissolve the clot.

The NINDS study, Carotid Revascularization Endarterectomy vs. Stenting Trial, (CREST), compared carotid artery stenting with endarterectomy and found that these two surgical procedures are equally effective in preventing future strokes. Your physician can talk to you about the best option for you. For more information about treating arterial stenosis and preventing stroke, visit http://www.ninds.nih.gov/disorders/stroke/arterial_stenosis_backgrounder.htm.

Clipping

One useful surgical procedure for treatment of brain aneurysms to prevent hemorrhage, or bleeding around the brain, is a technique called "clipping." An aneurysm is a weak or thin spot that develops on the wall of an artery or vein. Clipping involves an operation to apply a metal clip that closes off the aneurysm from the blood vessel, which greatly reduces the chance that it will bleed.

Detachable Coil Technique

The detachable coil technique is used by angiographers to treat intracranial aneurysms, or aneurysms that occur inside the skull. Angiographers use a catheter to insert a small platinum coil into the aneurysm, where it triggers clotting of the aneurysm. Stents are sometimes used to keep the normal artery open while the aneurysm clots off.

Arteriovenous Malformation

Arteriovenous malformations are a tangle of blood vessels inside the brain which may carry risk of bleeding. Surgery to remove the blood vessels may be possible in some patients. Angiographers can also sometimes insert a glue-like material to close off the feeding arteries to the tangled vessels. Radiation therapy can be used in small arteriovenous malformations to cause scarring and closing of the malformation over time.