Surgery can be used to prevent stroke, to treat acute stroke, or to repair vascular damage or malformations in and around the brain. There are two prominent types of surgery for stroke prevention and treatment: carotid endarterectomy and extracranial/intracranial (EC/IC) bypass. Carotid endarterectomy is a surgical procedure in which a doctor removes fatty deposits (plaque) from the inside of one of the carotid arteries, which are located in the neck and are the main suppliers of blood to the brain. As mentioned earlier, the disease atherosclerosis is characterized by the buildup of plaque on the inside of large arteries, and the blockage of an artery by this fatty material is called stenosis. The NINDS has sponsored two large clinical trials to test the efficacy of carotid endarterectomy: the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Trial (ACAS). These trials showed that carotid endarterectomy is a safe and effective stroke prevention therapy for most people with greater than 50 percent stenosis of the carotid arteries when performed by a qualified and experienced neurosurgeon or vascular surgeon.

Currently, the NINDS is sponsoring the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a large clinical trial designed to test the effectiveness of carotid endarterectomy versus a newer surgical procedure for carotid stenosis called stenting. The procedure involves inserting a long, thin catheter tube into an artery in the leg and threading the catheter through the vascular system into the narrow stenosis of the carotid artery in the neck. Once the catheter is in place in the carotid artery, the radiologist expands the stent with a balloon on the tip of the catheter. The CREST trial will test the effectiveness of the new surgical technique versus the established standard technique of carotid endarterectomy surgery.

EC/IC bypass surgery is a procedure that restores blood flow to a blood-deprived area of brain tissue by rerouting a healthy artery in the scalp to the area of brain tissue affected by a blocked artery. The NINDS-sponsored EC/IC Bypass Study tested the ability of this surgery to prevent recurrent strokes in stroke patients with atherosclerosis. The study showed that, in the long run, EC/IC does not seem to benefit these patients. The surgery is still performed occasionally for patients with aneurysms, some types of small artery disease, and certain vascular abnormalities. One useful surgical procedure for treatment of brain aneurysms that cause subarachnoid hemorrhage is a technique called "clipping." Clipping involves clamping off the aneurysm from the blood vessel, which reduces the chance that it will burst and bleed.

A new therapy that is gaining wide attention is the detachable coil technique for the treatment of high-risk intracranial aneurysms. A small platinum coil is inserted through an artery in the thigh and threaded through the arteries to the site of the aneurysm. The coil is then released into the aneurysm, where it evokes an immune response from the body. The body produces a blood clot inside the aneurysm, strengthening the artery walls and reducing the risk of rupture. Once the aneurysm is stabilized, a neurosurgeon can clip the aneurysm with less risk of hemorrhage and death to the patient.

Return to Know Stroke Home Page

Return to Sacred Heart Medical Center Home Page