Surgical Procedures for 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.

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.

Cerebral Aneurysm

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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.