A Complete Guide to Stroke Surgeries

Quick treatment is critical for stroke outcomes. It can reduce the amount of brain damage and even prevent potential death. In some cases, if specific criteria are met, strokes can be treated—or potentially prevented—with surgery or other procedures.

Read on to learn more about what types of procedures are recommended for stroke, as well as types of strokes and their symptoms.

Type of Strokes 

There are several different types of strokes. They are categorized based on their cause and by the region of the brain that is affected. Treatment and prevention are determined by the cause, while stroke rehabilitation is directed to regaining skills that were impaired by the stroke and maximizing self-care. 

Ischemic Stroke 

Ischemic stroke is the most common type of stroke. An ischemic stroke occurs when blood flow in an artery that supplies a region of the brain is interrupted. This causes damage to brain cells that are deprived of oxygen and infarction (an area of tissue death). 

Thrombotic stroke (cerebral thrombosis): A thrombotic stroke occurs when a blood clot forms in an artery in the brain. This can occur due to atherosclerosis (hardening of the arteries), which develops as a result of factors such as hypertension (high blood pressure), diabetes, and high cholesterol. 

Often, thrombotic strokes affect small blood vessels and cause damage to a small region of the brain, but these strokes can be large at times. 

Embolic stroke (cerebral embolism): An embolic stroke occurs when an artery in the brain is obstructed due to a blood clot or a plaque that travels to the brain from elsewhere, such as the heart or a carotid artery (a blood vessel in the neck that supplies blood and oxygen to the brain). A plaque contains cholesterol and other materials capable of forming embolisms. 

Often, an embolic stroke affects a large blood vessel in the brain and causes a large area of brain damage, but it can affect a smaller artery in the brain. 

Transient Ischemic Attack (TIA)

A TIA, also sometimes described as a ministroke, is a brief interruption of blood flow to a region in the brain. It causes symptoms of a stroke. With a TIA, the blood flow is restored before brain damage can occur, and the symptoms resolve on their own within a few minutes or hours. 

Sometimes TIAs can recur within hours or days, and a stroke may occur after a TIA. It is not possible to know whether stroke symptoms will resolve within a few minutes or whether they will be permanent, so it is important to get medical attention if you develop symptoms of a stroke or a TIA. 

Hemorrhagic Stroke 

A hemorrhagic stroke is a type of stroke that occurs when there is bleeding (hemorrhaging) in or around the brain. Bleeding causes brain damage, and the stroke also causes diminished blood supply to one or more regions of the brain. 

Subarachnoid hemorrhage: A subarachnoid hemorrhage is a type of hemorrhagic stroke that occurs when a blood vessel surrounding the brain leaks or bursts.

This causes blood to collect around the brain. It can cause compression of brain structures. Additionally, the leaking blood vessel may not provide adequate blood flow to the area of the brain that relies on it for blood supply. 

A subarachnoid hemorrhage may cause brain damage due to irritation from the blood, compression from the blood, and insufficient blood supply. A brain aneurysm is an outpouching defect of an artery, and it can leak or rupture, leading to a subarachnoid hemorrhage. 

Intracerebral hemorrhage: An intracerebral hemorrhage is bleeding within the brain tissue. It can occur due to a leaking blood vessel or bleeding of an ischemic area. 

An intracerebral hemorrhage causes damage from the presence of blood and due to insufficient blood supply. It usually also causes edema (swelling), which can cause severe pressure in the brain. 

Risk Factors and Causes of Stroke 

Many different medical issues and lifestyle factors can lead to a stroke, and several of these factors are intertwined. For example, physical inactivity is a risk factor for obesity, diabetes, and high cholesterol. Each of these contributes to stroke risk. 

Lifestyle Risks 

Lifestyle habits play a strong role in your stroke risk:

• Smoking: Smoking damages the inner lining of the blood vessels throughout the body, contributing to atherosclerosis. 
• Obesity, physical inactivity: Physical inactivity increases the risk of obesity. Physical inactivity and obesity each increase the risk of unhealthy cholesterol levels, hypertension, and diabetes. 

Risks From Health Conditions 

Certain health conditions can cause or increase the risk of stroke:

• High blood pressure: Hypertension is harmful to blood vessels, and it contributes to cerebrovascular disease. High blood pressure leads to carotid artery disease and coronary artery disease (buildup of plaque, a collection of cholesterol and other substances, in the arteries that supply the heart muscle). 
• Carotid artery disease: Buildup of plaque and narrowing of the carotid arteries on each side of the neck can lead to a stroke. 
• Heart disease: Heart disease, including arrhythmia (irregular heart rhythm), valve disease, and congestive heart failure (when the heart is unable to pump enough blood to meet the body’s needs), can increase the risk of an embolic stroke. 
• Diabetes: Diabetes (inability of the body to maintain proper blood sugar levels) can damage blood vessel walls and increase the risk of atherosclerosis, especially if blood sugar levels are not well controlled with diet and medication. 
• High cholesterol: Atherosclerosis is associated with high levels of low-density lipoprotein (LDL) and triglycerides, as well as low levels of high-density lipoprotein (HDL). Your cholesterol levels can be affected by your diet, exercise, weight, smoking, and hereditary factors. 

Health History Risks 

Your health history can provide some insight into your stroke risk, including:

• History of TIAs: If you have had one or more TIA, you are at a high risk of having a stroke. It is important to have an assessment of stroke risk factors and to get treatment if you have ever had a TIA. 
• History of stroke: Having a stroke is associated with an increased risk of having another stroke. This risk can be reduced by getting treatment for your stroke risk factors. 
• Family history: If you have a family history of strokes, you may also be at a higher-than-average stroke risk. Make sure you tell your doctor about your family history and have an assessment of your own stroke risk factors. 

Demographics 

Some inherent factors affect your risk of having a stroke, including: 

• Age: In general, the risk of stroke increases with advancing age. Some young people also are at risk of stroke due to congenital (from birth) health issues, such as heart defects or abnormal blood vessels.
• Gender: Women have a higher incidence of stroke than men, especially during the postmenopausal years, in association with longer life expectancy. 
• Race: According to the American Heart Association, stroke risk factors impact people of various races differently. Black Americans have a higher overall risk of stroke than all other populations.

Stroke Symptoms 

A stroke can cause different symptoms, depending on the area of the brain that is affected. Symptoms begin suddenly and can worsen within minutes or hours. 

Symptoms of a stroke may include: 

• Face, arm, or leg weakness on one side of the body 
• Blurred vision or decreased vision 
• Difficulty speaking or communicating 
• Confusion 
• Dizziness 
• A severe headache 
• Altered sensation on one side of the body
• Poor coordination and walking difficulties 

Get medical attention promptly if you experience these symptoms or if you witness someone else having these symptoms. 

These symptoms can change over time and may improve. Usually, the effects of a stroke will not worsen after the stroke has stabilized over the course of the first few days. Sometimes the stable effects of a stroke can temporarily worsen if you have medical problems, such as an infection or if your blood sugar becomes too high or too low.

Ischemic Stroke Surgeries and Other Stroke Treatments 

Sometimes interventional procedures are part of stroke treatment and prevention. These treatments are not beneficial for everyone and are only used when certain criteria are met.  

Tissue Plasminogen Activator (TPA)

This powerful blood thinner can be administered intravenously (IV, within a vein) to dissolve a blood clot when an acute ischemic stroke is diagnosed within a few hours after the first symptoms begin. It can cause a risk of bleeding, and people who have certain medical conditions or who are at risk of bleeding cannot receive TPA for stroke treatment. 

Sometimes, this treatment restores blood flow to the area of the brain that is affected by a stroke, which prevents or reduces the severity of brain damage. Results may not appear immediately or abruptly, but there's a relative improvement in outcomes when TPA is made available to patients.

Emergency Stroke Treatment: Neurointerventional Procedures 

Sometimes medication can be directly injected to dissolve a blood clot that is causing a stroke. During this procedure, a catheter (tube) is inserted into a blood vessel (usually in the groin) and advanced to the blood clot using real-time imaging guidance. 

Sometimes severe swelling can develop in the brain after a large stroke. This can be dangerous and can increase the risk of death.

One of the treatments for excessive swelling after a stroke is craniectomy or hemicraniectomy, a procedure in which a portion of the skull is temporarily removed in the operating room to prevent pressure on the brain from the swelling. The bone is then replaced at a later time when the pressure is relieved. 

Clot Retrieval Devices 

In some situations, a blood clot can be directly removed with an interventional procedure. Imaging guidance is used. This treatment is done within hours or in some cases, even 24 hours after stroke symptoms begin.

Medical Prevention (Anticoagulation, Anti-platelets)

Often, daily medication is prescribed to reduce the risk of blood clot formation for people who have a history of ischemic stroke. This may be an anticoagulant (blood-thinner) or an antiplatelet medication. Blood thinners may be used especially if there is a history of atrial fibrillation.

Carotid Endarterectomy Surgery (CEA)

For severe carotid artery disease, carotid endarterectomy surgery may be necessary to remove a section of damage from the artery, reducing the risk of a stroke.

Carotid Angioplasty and Stenting

Sometimes, instead of open carotid endarterectomy surgery, a minimally invasive procedure is done to prevent a stroke. This can involve stenting (placement of a tube in the vessel to keep it open). 

Hemorrhagic Stroke Surgeries and Other Stroke Treatments 

The preventive and emergency treatments for a hemorrhagic stroke are different than the treatments for an ischemic stroke. 

Surgery/Clipping 

Sometimes a brain aneurysm must be surgically repaired to prevent it from rupturing. This may be done with an open surgery that requires removal of a portion of the skull for access to the aneurysm. 

Surgical repair involves clipping of an aneurysm with a metal clip that causes the outpouching to wither away so the blood vessel will safely heal.

Often, aneurysm clipping is done to prevent a rupture, but sometimes it is done after an aneurysm has ruptured. Sometimes, excess blood that accumulates near the brain after an aneurysm rupture has to be surgically removed as well.

Endovascular (Neurointerventional) Treatment 

An aneurysm can be repaired with a minimally invasive procedure in which a catheter is used to repair the aneurysm with imaging guidance. 

The decision between surgical clipping and endovascular repair is often determined by the location of the aneurysm.

Summary 

Surgery can be one of the ways to treat or prevent a stroke for some people. You might need preventive surgery if you have a brain aneurysm or severe carotid artery stenosis.

Sometimes surgery is needed to prevent brain damage from a stroke. This can include neuro-interventional procedures to remove or dissolve a blood clot, surgery to remove blood from an aneurysm rupture, or surgery to relieve severe swelling of the brain after a stroke. 

A Word From Verywell 

Surgery can be part of stroke care. Sometimes surgery is recommended for stroke prevention. Usually, if surgery is needed for stroke prevention, you can expect to fully recover and return to your normal activities.

There are also certain circumstances when surgery can help reduce brain damage from a stroke. If you are having surgery after a stroke, recovery can take months or longer as part of stroke rehabilitation. If you qualify for an acute stroke rehabilitation program, it is recommended that you attend for best long-term outcomes.