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Surgery can be done to restore and/or improve blood flow to the brain. When a stroke is severe, surgery may be done without delay. Keep in mind that many procedures may not cure the cause of your stroke or repair damage. It will help restore blood flow and prevent further damage. A healthy lifestyle that includes achieving a healthy weight, eating a heart healthy diet, not smoking, and taking recommended medications is still important.

Surgery Options to Prevent Further Damage During a Stroke

Decompressive Craniotomy

Occasionally, a large stroke can lead to significant brain swelling. When this happens and medications do not help relieve the swelling, a surgical intervention may be needed to prevent the pressure buildup within the skull from causing further damage to the brain. In this procedure, a flap of bone overlaying the swelling may be temporarily opened in order to relieve the pressure.

If the stroke is of the hemorrhagic type, the blood clot may also be removed to prevent further brain injury.

Catheter Embolectomy

This is a procedure used to treat acute strokes. A tiny, flexible tube called a catheter is threaded through the blood vessels until it reaches the area in the brain where the clot is lodged. Efforts are made to remove the clot through the catheter, or clot-busting agents are given through the catheter to the location of the actual clot.

Mechanical devices may be used to remove a clot. Other devices have either a corkscrew tip or a special ring used to remove the clots. They are placed in a catheter and threaded through blood vessels to the area of the blockage. When the device is in the proper location, it is used to remove the clot blocking the blood vessel. The advantage of these devices is that they can remove the clot in minutes, opening blood flow and decreasing the level of damage to affected tissue.

Surgery to Prevent Another Stroke

Atherosclerosis (fatty deposits) in the arteries in the brain or the arteries that lead to the brain may increase the risk of another stroke. These fatty deposits may result in:

  • Narrowing of an artery that will eventually shut off the blood supply to the brain
  • Ulceration of a hardened fatty deposit (plaque) that makes it likely to break off and obstruct the artery further down stream

Surgery attempts to correct either or both events. Very careful evaluation is need to determine which lesions will benefit from surgery. Procedures may include:

Arterial Bypass

During this operation, a narrow area of your artery, usually the carotid artery, can be bypassed by sewing in a replacement tube above and below the obstruction. The bypass may go around a short narrowed segment of a carotid artery, or it may connect an artery inside the skull with one from outside the skull.

Carotid Artery Endarterectomy (CEA)

Very similar to an arterial bypass and requiring that a bypass be used temporarily during the surgery, an endarterectomy carves out the inner lining of the carotid artery. It leaves behind the outer layers to carry the blood. There are technical reasons why one procedure is preferred over the other. CEA is performed much more commonly than arterial bypass for atherosclerotic disease of the carotid arteries.

Angioplasty

A catheter is threaded through the blood vessels and into the carotid artery or, less commonly, another artery in the brain. A balloon is introduced through the catheter and inflated within the blood vessel, in an effort to widen the blood vessel and improve blood flow through it. A mesh tube called a stent is often left within the artery to keep it as open as possible. A mesh screen may be placed within the artery to catch any bits of plaque or clots that might otherwise flow upward into the brain.

Even though endarterectomy is more invasive, it may be preferred over angioplasty for some people. Angioplasty may be an option for those who are have a high risk of complications from CEA.

Aneurysm Repair

Aneurysms are weak spots in arteries that balloon out and may rupture, allowing blood at high pressure to pump into neighboring tissues. It is sometimes possible to repair an aneurysm before it causes a major hemorrhagic stroke. An enlarging aneurysm may produce pressure in the brain before it ruptures. Or, it may leak slowly enough to allow detection and repair before the major bleeding begins.

Cerebral Aneurysm
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The goal is removal or clipping of a small weak spot on a blood vessel. Once visualized, the standard procedure is to clamp a small metal clip around the base of the aneurysm.

There are alternatives that can be accomplished without surgically entering the skull. Aneurysms are connected to the circulation and can be approached through blood vessels by threading long, thin catheters into them. It may then be possible to block the aneurysm from inside, perhaps by inserting metal coils or squirting them full of tiny beads or other compounds. These will cause a clot to form and scar.

Treating Heart Conditions

In many cases, stroke may be the result of cardiovascular disease that affects the heart. You may need surgery to correct these causes to reduce your risk of another stroke. Heart surgery may include:

  • Heart valve replacement —Replacing leaky or faulty heart valves improves the heart's ability to pump blood.
  • Cardiac thrombosis surgery —A blood clot can form on the valves or in the chambers of the heart. If the blood clot is not reduced with medication, surgery may be to remove the clot.
  • Repair of defects present from birth —An abnormality in the heart's structure may cause blockage or abnormal patterns of blood flow inside the heart. Repairing defects helps the heart function better and improves blood flow throughout the body.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 11/2013 -
  • Update Date: 06/16/2014 -
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