Surgical Procedures for Strokeby Ricker Polsdorfer, MD
Surgery for stroke technically falls into the prevention category, but is covered here because it is surgical in nature.
Two conditions in the arteries that lead to the brain can predispose you to stroke. Both are the result of atherosclerosis (fatty deposits in the arteries), which can lead to:
A narrow area of your artery, usually the carotid artery, can be bypassed by sewing in a replacement tube above and below the obstruction.
This surgery is nearly always done on the carotid arteries, which lie on either side of your windpipe. It may also be done between a scalp artery and a vessel inside your skull.
After attaching you to monitoring devices in the surgical suite, you will be under general anesthesia. The surgeon will cut the skin over the involved artery or arteries, remove a piece of your skull if necessary, and sew a piece of tubing (Dacron or a vein that has been taken from your leg) between a healthy artery and the diseased one. The bypass may simply 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.
The inner lining of these arteries is thickened and irregular and may contain deposits of calcium, but the outer layers may be healthy.
Very similar to a bypass, and requiring one at least temporarily, an endarterectomy simply carves out the inner lining, leaving behind the outer layers to carry the blood. There are technical reasons why one procedure is preferred over the other in any given individual. Endarterectomies are performed much more commonly than arterial bypasses for atherosclerotic disease of the carotid arteries.
Repairing an Aneurysm
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.
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Brain aneurysm surgery is brain surgery, with all the meticulous care and technology directed at safe, effective results. The goal is removal 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 high-tech 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 (tiny tubes) into them. It may then be possible to block them from inside, perhaps by inserting metal coils or squirting them full of tiny beads that will cause a clot to form and scar them down.
Harrison's Principles of Internal Medicine, 14th ed. McGraw-Hill;1998.
Last reviewed November 2003 by Andrew Wilner, MD, FACP
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