Stroke

Surgery

Surgery following stroke is relatively rare and only for specific cases is it helpful in treating and preventing a stroke.

Surgery following a brain haemorrhage

A few people had surgery following a brain haemorrhage (bleed in the brain). An operation is sometimes performed to remove blood from the brain and occasionally to repair the leaking blood vessel. If this happened, the operation was usually performed in an emergency, lifesaving situation and the person had not been fully conscious before surgery and had been in intensive care after so had no memory of the operation.

One woman, however, had a relatively rare condition in which a malfunction of the connections between arteries and veins in the brain caused a haemorrhage. This was identified by an angiogram (see 'Getting a diagnosis'). She underwent a special procedure using stereotactic radiotherapy to repair the connections and was awake during the procedure.

Carotid Endarterectomy 

Sometimes a stroke is caused by a block in one or both of the carotid arteries which carry blood to the brain through the neck. If it is suspected that this might be the cause of the stroke then a scan of the carotid arteries is performed to look at the extent of the blockage (see 'Getting a diagnosis').  

Carotid endarterectomy is usually only performed when there is a partial block and removal of the blockage will help prevent a further stroke or minor strokes. Several people had more major strokes due to a complete block in the carotid artery and were told that an operation would not help improve function or prevent another stroke.

A few people had been experiencing Transient Ischaemic Attacks (TIAs) or minor strokes as a result of a partial block in the carotid artery and were offered surgery to clear the blockage.The main treatment options for severe blockages in the carotid artery are carotid endarterectomy, and carotid angioplasty or stenting.

Carotid endarterectomy is an operation to clear the blockages in an artery. The surgeon will make a small incision (cut) in the side of the neck so they can see the carotid artery, which will then be clamped shut. The surgeon will then open up the artery and remove the inner lining along with any debris. It is likely that a graft will then be sewn onto the artery to widen it - most surgeons believe this lowers the risk of a repeat stroke. A graft is a piece of tissue that may be taken from a vein in the thigh, or it may be man-made. When the surgeon is finished the artery will be stitched up, the blood supply restored, and the small cut in the neck sewn up (Description of surgery from Stroke Association April 2012)
 
Carotid angioplasty is carried out under local anaesthetic. A small flexible tube is passed into the carotid artery through an artery in the groin. The tube has a small balloon at the end of it. When the tube reaches the narrowed area, the balloon is inflated. This expands the artery, allowing the blood to flow through it again. The balloon is then removed.
 
Carotid stenting involves the same procedure at first, but once the balloon is inflated, a small wire mesh cylinder called a stent is then inserted to keep the artery open, improving blood flow. The stent will stay there permanently.

Surgery is most successful when the arteries are between 70 and 99% narrower than they should be. It is most effective when carried out within two weeks of a stroke. NICE- National Institute for Health Care Excellence recommends surgery within 2 weeks (CG68 March 2017)  “In people who have previously had a stroke or a TIA, their risk of having another stroke or TIA within the next three years is reduced by a third after surgery.” NHS choices 2015.

Those who were offered a carotid endarterectomy had been told that it was 95% successful but that there was a risk of having a stroke during the surgery. One woman was quite nervous about the operation and initially decided to put it off, however, when she continued to get TIAs she decided to go ahead with the surgery. She chose to have the surgery under general anaesthetic because she was quite nervous.

Another man decided that surgery was his best option and underwent two different operations to remove blockages from both carotid arteries. Although both operations were eventually successful during the first one there was a problem with his heart and he needed to be resuscitated.

He was awake during both procedures and said that he felt no pain but could feel slight tugs as they worked on his neck.

Both people who had this operation said they recovered quickly and were able to go home within a few days. The woman had felt some slight numbness around her neck and was warned that she may feel some dizziness for a few weeks. This is quite normal and usually fades with time.

Occasionally blood can take a shortcut through a small hole in one of the heart walls, which can result in TIA and stroke and can be treated with anticoagulant medication or implanting a device to block the hole – recent research has not shown that devices work any better than medication.

A few people had heard of pioneering research using stem cell therapy, where stem cells are injected into the brain close to the stroke site, and wondered if it worked. Clinical trials have only just begun to assess its effectiveness.
 

Last reviewed June 2017.
Last updated June 2017.

 

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