Surgery and other procedures

Stroke surgery

Sometimes surgery is needed to treat a stroke. Some of the procedures include:

Surgery to remove blood clots

A hematoma is a collection of blood (the blood can be clotted or mostly clotted) found in the brain after a hemorrhagic (bleeding) stroke. Because there is not much extra room in the skull, a hematoma can dangerously increase pressure on the brain, causing more brain damage. Surgery may be needed to remove the hematoma and relieve the pressure on the brain.

Surgery to repair blood vessels

Some hemorrhagic (bleeding) strokes are caused by a burst or ruptured blood vessel in the brain. The two common types of ruptures are aneurysms (a weak spot in the wall of the blood vessel) and arteriovenous malformation (AVM), an area where the blood vessels have thin walls and are prone to leaking or breaking. In some cases, surgery may be needed to repair the ruptured blood vessels. Non-surgical procedures are also sometimes an option to repair these ruptures.

Surgery to remove plaque from the carotid artery

When the carotid artery in the neck is partially blocked by plaque (the buildup of fatty materials, calcium and scar tissue that narrows the artery), surgery called carotid endarterectomy might be used to remove the plaque. The procedure helps prevent a first stroke or reduces the risk of a second or third stroke. It works best for people whose artery is narrowed but not completely blocked.

The risks of this surgery include stroke, heart attack and, rarely, a brain hemorrhage caused by the surge of blood released by the surgery. People with high blood pressure are at greater risk of a hemorrhage. Carotid endarterectomy is usually recommended for people who have had a TIA (transient ischemic attack or mini stroke) or stroke, have severe blockage of the carotid artery or are likely to recover well from surgery.

Non-surgical procedures

These procedures use a thin, narrow, flexible tube called a catheter, which is inserted into the body, usually in the groin, and threaded through the blood vessels to the carotid arteries in the neck.

Carotid angioplasty and stenting

This is a newer type of procedure that is similar to angioplasty and stenting often done in the coronary arteries of the heart. The procedure involves using a balloon-like device to open a clogged artery. Then, a small metal stent is put in place to help keep the artery open.

Coiling aneurysms

Aneurysms are weak spots in the walls of blood vessels that can rupture and cause bleeding (hemorrhage) in the brain. If an aneurysm ruptures (causing a subarachnoid hemorrhage), immediate surgery may be required. If an aneurysm has not ruptured, it can sometimes be treated by filling the blood vessel with tiny flexible coils made of platinum. This procedure can only be performed if the aneurysm has not yet ruptured and the patient has an appropriate neck size. The coils are put into place by a catheter that is threaded through the blood vessels.

Last reviewed: August 2008.