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.

a mesh tube may be placed inside the artery to help hold it open. Some patients can be helped by a procedure called angioplasty (AN-jee-oh-plass-tee). They are called the carotid (kuh-RAW-tid) arteries. Blood can then flow freely through the artery to the brain. For Blockage in the Neck The main arteries in the neck help supply the brain with blood. The tube is called a stent. A patient usually stays in the hospital 2 to 3 days for this operation. . which is also called a TIA. When patients have a serious blockage in these arteries. This procedure cleans out and opens up the narrowed artery. Life-saving surgery may be necessary to remove the clot and the brain tissue that has died from lack of oxygen. When the balloon is inflated. Sometimes clots form. If an aneurysm has not ruptured. A harmful fatty deposit. a tiny balloon at the end of a long. The coils are put into place by a catheter that is threaded through the blood vessels. a small metal stent is put in place to help keep the artery open.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. and severe brain swelling may result. A blockage also can occur when the artery itself narrows. ypes of surgery After receiving emergency care. For Strokes from Blockage Most strokes occur when a blood vessel in the brain is blocked and blood flow stops. may build up in an artery and then block it. The procedure involves using a balloon-like device to open a clogged artery. it can sometimes be treated by filling the blood vessel with tiny flexible coils made of platinum. called plaque (PLAK). This type of stroke is called an ischemic (iss-KEYmik) stroke. The blockage may be caused by a blood clot. Then. surgery may be done to prevent a stroke or a ministroke. During the operation. the surgeon scrapes away plaque from the wall of the artery. Coiling aneurysms Aneurysms are weak spots in the walls of blood vessels that can rupture and cause bleeding (hemorrhage) in the brain. The procedure usually requires a hospital stay of several days. some stroke patients may be helped by surgery. In addition. During the procedure. This procedure can only be performed if the aneurysm has not yet ruptured and the patient has an appropriate neck size. immediate surgery may be required. thin tube is pushed through the artery to the blockage. If an aneurysm ruptures (causing a subarachnoid hemorrhage). it opens the artery. The operation is called a carotid endarterectomy (en-dar-ter-EK-tuh-mee). which can then break off and travel to block another artery in the brain.

the weakened artery may become like a balloon filled with blood. During the operation. There are several types of surgery to repair an aneurysm. the brain works normally. While the brain is not getting enough blood. an artery on the outside of the scalp is re-routed to the part of the brain that is not getting enough blood flow. When an aneurysm occurs. is a procedure in which blood vessel blockage (fatty plaque) is surgically removed from the carotid artery. There are two types of strokes: hemorrhagic or ischemic. A clip may be placed across the neck of the aneurysm (like a clip at the end of a balloon) to stop the bleeding. which stands for transient (TRANS-yent) ischemic (iss-KEY-mik) attack. Immediate treatment may minimize the long-term effects of a stroke and prevent death. When a Stroke Occurs: Quick Stroke Treatment Can Save Lives If you’re having a stroke.  Angioplasty/Stents Doctors sometimes use balloon angioplasty and implantable steel screens called stents to treat cardiovascular disease and help open up the blocked blood vessel. Patients usually describe an aneurysm as the worst headache of their life. thin tube through the artery that leads to the aneurysm. This is called an aneurysm (AN-your-izm). An ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases. also called carotid artery surgery. These strokes are called hemorrhagic (HEMer-RAJ-ik).For Strokes from Altered Blood Flow Blood flow to the brain may decrease temporarily in some patients. The bleeding may occur when a weakened blood vessel leaks or bursts. Based on the type of surgery. Patients who have TIAs get symptoms for a short time that make it difficult for them to function. it’s critical that you get medical attention right away.  Carotid Endarterectomy Carotid endarterectomy. A newer approach is to thread a long. The hospital stay for this type of bypass surgery is about one week. the hospital stay ranges from several days to a week or longer. A hemorrhagic stroke occurs when a weakened blood vessel ruptures and spills blood into brain tissue. This is called a ministroke or a TIA. Bypass surgery may be advised for some patients who continue to have TIAs. When blood flow is restored. and the symptoms disappear. There are two other types of weakened blood vessels that also cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs). Ischemic Stroke Treatment tPA. the Gold Standard . For Strokes from Bleeding Bleeding in the brain causes some strokes. View a detailed illustration of carotid endarterectomy (opens in new window). Then a tiny coil is fed through the tube into the aneurysm “balloon” to fill the space and seal off the bleeding. Treatment differs depending on the type of stroke. it cannot work properly. The most common cause for the rupture is uncontrolled hypertension (high blood pressure).

a metal clip may be placed surgically at the base of the aneurysm to secure it.The only FDA approved treatment for ischemic strokes is tissue plasminogen activator (tPA. a surgeon removes plaque buildup in . or by an abnormal tangle of blood vessels (AVM). and only after a patient receives tPA. tPA works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. These procedures are less invasive than surgical treatments. Image courtesy of Medtronic Hemorrhagic Stroke Treatment Endovascular Procedures Endovascular procedures may be used to treat certain hemorrhagic strokes similar to the way the procedure is used for treating an ischemic stroke.5 hours in certain eligible patients). to prevent rupture. this is why it’s so important to identify a stroke immediately. During this surgery. in which trained doctors try removing a large blood clot by sending a wired-caged device called a stent retriever. Endovascular Procedures Another treatment option is an endovascular procedure* called mechanical thrombectomy. surgical treatment may be done to stop the bleeding. Special suction tubes may also be used. allowing doctors to remove the stent with the trapped clot. your age. it then deposits a mechanical agent. you may need a carotid endarterectomy. Surgical Treatment For strokes caused by a bleed within the brain (hemorrhagic stroke). and current condition are major factors in the decision. also known as IV rtPA. strongly recommended. given through an IV in the arm). To remove the brain clot. If administered within 3 hours(and up to 4. If the bleed is caused by a ruptured aneurysm (swelling of the vessel that breaks). *Note: Patients must meet certain criteria to be eligible for this procedure. Surgery for ischemic stroke If you have serious blockage in the carotid arteries in your neck. tPA may improve the chances of recovering from a stroke. prior overall health. The stent opens and Stent retrieving device used to remove large clots* grabs the clot. such as a coil. and involve the use of a catheter introduced through a major artery in the leg or arm. Surgery When surgery is being considered after a stroke. A significant number of stroke victims don’t get to the hospital in time for tPA treatment. to the site of the blocked blood vessel in the brain. then guided to the aneurysm or AVM. doctors thread a catheter through an artery in the groin up to the blocked artery in the brain. The procedure should be done within six hours of acute stroke symptoms.

and mental disabilities. . It is crucial that proper blood flow and oxygen be restored to the brain as soon as possible. sometimes resulting in physical. and the results can be devastating.the carotid arteries. Ischemic Stroke   Thrombotic (cerebral thrombosis) is the most common type of ischemic stroke. Once brain cells die. Stroke Prevention: Should I Have a Carotid Artery Procedure? Surgery for hemorrhagic stroke Treatment for hemorrhagic stroke may include surgery to:  Drain or remove blood that is in or around the brain. Stroke Stroke is an abrupt interruption of constant blood flow to the brain that causes loss of neurological function. is pushed through the bloodstream and lodges in narrower brain arteries. In an endovascular embolization.  Repair a brain aneurysm.  Remove or block off abnormally formed blood vessels (arteriovenous malformation) that have caused bleeding in the brain. In a craniotomy. a small metal clip is placed around the base of the aneurysm o to block it off. the affected brain cells are either damaged or die within a few minutes. Without oxygen and important nutrients. and devastating damage may occur. Embolic (cerebral embolism) is caused when a clot or a small piece of plaque formed in one of the arteries leading to the brain or in the heart. blocking blood flow. because the surgery itself may cause a stroke. leading to the more deadly hemorrhagic stroke. cognitive. Ischemic stroke constitutes an estimated 87 percent of all stroke cases. The interruption of blood flow can be caused by a blockage. A blood clot forms inside a diseased or damaged artery in the brain resulting from atherosclerosis (cholesterol-containing deposits called plaque). they generally do not regenerate. This stops the bleeding in the brain. leading to the more common ischemic stroke. The benefits and risks of this surgery must be carefully weighed. Stroke often occurs with little or no warning. soft metal coils or mesh is inserted into o the aneurysm to block it off and stop or prevent bleeding. or by bleeding in the brain. The blood supply is cut off from the brain due to the clogged vessel.

4 million stroke survivors currently alive today. Of all strokes. Of the more than 795. stroke cost about $73. Usually these symptoms resolve in less than 10 to 20 minutes.7 billion in both direct and indirect costs in the United States alone. A common cause of subarachnoid hemorrhagic stroke is a ruptured cerebral aneurysm. and is treated as a neurological emergency. a tangle of abnormal and poorly formed blood vessels (arteries and veins). Hemorrhagic Stroke   Subarachnoid Hemorrhage: bleeding that occurs in the space between the surface of them brain and the skull. Heart Disease and Stroke Statistics . 10 percent are intracerebral hemorrhage. Stroke is a leading cause of serious long-term disability. there has been a steady decline in mortality rates since 2002. strokes can occur at any age. with an estimated 5.2010 Update. and 185.592 people in the United States died from cerebrovascular disease in 2007. an area where a blood vessel in the brain weakens. Stroke Statistics         Stroke is the third leading cause of death in the United States. Statistics indicate that an estimated 135.Transient ischemic attack (TIA) This is a warning sign of a possible future stroke. About 25 percent of people who recover from their first stroke will have another stroke within five years. loss or blurring of vision in one eye. it is very important that anyone experiencing these symptoms call 911 and immediately be evaluated by a qualified physician. In 2010. Common temporary symptoms include difficulty speaking or understanding others. with an innate propensity to bleed. and loss of strength or numbness in an arm or leg. and 3 percent are subarachnoid hemorrhage. and almost always within one hour. While the incidence has increased. 87 percent are ischemic.000 people affected every year. Many intracerebral hemorrhages are due to changes in the arteries caused by long-term hypertension.000 are recurrent. Intracerebral Hemorrhage: bleeding that occurs within the brain tissue. or the rupture of an arteriovenous malformation. Understanding the factors that increase your risk of a stroke and recognizing the symptoms may help you prevent a stroke. Source: American Heart Association.000 of these are first attacks. . Even if all the symptoms resolve. Receiving early diagnosis and treatment may improve your chances for complete recovery. resulting in a bulging or ballooning out of part of the vessel wall. Other potential causes may be delineated through testing. about 610. Risk Factors Although they are more common in older adults.

have strokes. Getting 30 minutes of moderate exercise. Recent studies show that high levels of LDL (bad) cholesterol (greater than 100 mg/dL) and triglycerides(blood fats. Check with your doctor first before starting any exercise program if you have any health problems or have been inactive. Recent research shows evidence that people receiving hormone replacement therapy (HRT) have an overall 29 percent increased risk of stroke. in particular ischemic stroke. Carotid or other artery disease: The carotid arteries in your neck supply blood to your brain. the greater your risk of stroke. especially when untreated. a procedure in which an incision is made in the neck and plaque is removed from the artery. Diabetes: It is crucial to control your blood sugar levels. In most age groups. It usually has no specific symptoms and no early warning signs. Some research has indicated that women may experience and interpret stroke symptoms differently than men. You can often improve your cholesterol levels by decreasing the salt and saturated fat in your diet. History of TIAs: About 30 percent of strokes are preceded by one or more TIAs that can occur days. African Americans have more than two times the risk . and must take medication to control it. Carotid arteries are treated by neurosurgeons through carotid endarterectomy. which raises your risk of stroke. Controlling your blood pressure is crucial to stroke prevention. five days a week can help reduce your risk of stroke. diabetes. obese or both can increase your risk of high blood pressure. they still may have high cholesterol. There is recent evidence that long-term secondhand smoke exposure may increase your risk of stroke. Physical inactivity and obesity: Being inactive. Heredity and race: You have a greater risk of stroke if a parent. and cholesterol levels. Gender: Stroke is more common in men than in women. high blood cholesterol. puts you at greater risk of stroke and has many other serious health implications. sister or brother has had a stroke. However. Uncontrollable risk factors include:    Age: People of all ages. weeks or even months before a stroke. more men than women will have a stroke in a given year. High blood pressure: Blood pressure of 140/90 mm Hg or higher is the most important risk factor for stroke. an endovascular procedure that requires no surgical incision in the neck. and contributing to their higher stroke mortality rates. Diabetes. Your risk may be increased further if you use some forms of oral contraceptives and are a smoker. women account for more than half of all stroke deaths. some people inherit genes associated with elevated levels of cholesterol. blood pressure. or carotid artery angioplasty and stenting. ischemic stroke or TIAs. Women who are pregnant have a higher stroke risk. Low levels (less than 40 mg/dL) of HDL (good) cholesterol also may increase stroke risk. But the older you are. 150 mg/dL or higher) increase the risk of stroke in people with previous coronary heart disease. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked by a blood clot. causing them to delay seeking medical care. including children. Although they may eat well and exercise. High blood cholesterol: A high level of total cholesterol in the blood (240 mg/dL or higher) is a major risk factor for heart disease. However. grandparent. That’s why it is important to have your blood pressure checked regularly. heart disease and stroke.Controllable or treatable risk factors for stroke include:         Smoking: You can decrease your risk by quitting smoking.

A stroke on the right side may result in the following:     Paralysis on the left side of the body Vision problems Quick. Warning signs may include some or all of the following symptoms:          Dizziness. or the ability to walk It is especially important to note that many strokes may cause an utterly painless loss of neurological function. Such technical advances as digital imaging. Stroke Effects The effects of a stroke depend primarily on the location of the obstruction and the extent of brain tissue affected. its treatment or its prevention. but the early diagnosis of a stroke. or vomiting Unusually severe headache Confusion. nausea. cautious behavior Memory loss Stroke Treatment Rehabilitation following a stroke may involve a number of medical specialists. disorientation or memory loss Numbness. you are also at higher risk of having a stroke. microcatheters and other neurointerventional . especially on one side Abnormal or slurred speech Difficulty with comprehension Loss of vision or difficulty seeing Loss of balance. can be undertaken by a neurosurgeon. Rapid and accurate diagnosis of the kind of stroke and the exact location of its damage is critical to successful treatment. If you have had a heart attack. coordination. you are at much higher risk of having another one. of stroke compared to Caucasians. One side of the brain controls the opposite side of the body. Hispanics also have an elevated stroke risk. so a stroke affecting the right side will result in neurological complications on the left side of the body. Stroke Symptoms The range and severity of early stroke symptoms vary considerably. weakness in an arm. partly related to the prevalence of hypertension. but they share the common characteristic of being sudden. Prior stroke or heart attack: If you have had a stroke. inquisitive or purposeless behavior Memory loss A stroke on the left side may result in the following:     Paralysis on the right side of the body Speech/language problems Slow. leg or the face. leading to potential hesitation to call 911 or visit an emergency room.

The time limit to implement this type of intervention is also significantly (double) longer than that for IV TPA. Ischemic Stroke Treatment Ischemic stroke is treated by removing obstruction and restoring blood flow to the brain. Clot Retrieval Devices The Merci Retriever. A microguidewire is used to navigate the microcatheter to the site of obstruction in the brain. is more specific than IV (intravenous) tPA. At the neck. Generally. delivered through a larger guiding catheter inserted at the groin through a small incision.technologies. a small catheter inside the larger catheter is guided through the arteries into the brain. and consequently may require significantly lesser dosages of medication. which delivers thrombolytic medication intraarterially. until it reaches the brain clot. approved in 2004 by the FDA.shaped device used to help remove blood clots from the arteries of stroke patients. the use of the operating microscope (microsurgery) and the surgical laser have made it possible to treat stroke problems that were inoperable a few years ago. and the actual use of tPA is considerably lower. Unfortunately. A . This medication carries a risk for increased intracranial hemorrhage and is not used for hemorrhagic stroke. which must be administered within a threehour window from the onset of symptoms to work best. is a corkscrew. Thrombolytic medication such as tPA can then be administered directly to the occluding thrombus. into which a small catheter is fed until it reaches the arteries in the neck. A small incision is made in the patient’s groin. only Comprehensive Stroke Care Centers offer this type of treatment. The only FDA-approved medication for ischemic stroke is tissue plasminogen activator (tPA). Emergency Surgical Stroke Treatment: Neurointerventional Procedures Microcatheter-based surgical interventions for stroke have in common the use of a small microcatheter. This kind of treatment. only 3 to 5 percent of those who suffer a stroke reach the hospital in time to be considered for this treatment.

Anticoagulants thin the blood and prevent clotting. Heparin acts quickly and is given intravenously (through a vein) or subcutaneously (beneath the skin) while a patient is in the hospital. Penumbra is also a microcatheter-based system device. which works by an aspiration principle. Preventive Surgical Procedures Carotid Endarterectomy Surgery (Carotid Endarterectomy. travel through the bloodstream. The clot is removed through the catheter with a syringe. the neurosurgeon makes . Antiplatelet drugs prevent platelet aggregation. Slower-acting warfarin can be given orally and is used over a longer period. reducing the risk of ischemic stroke in patients who have had TIA or prior ischemic stroke. so the device can pull the clot out of the brain safely. they require close monitoring by a physician. Because these drugs affect the blood's ability to clot. combined with aspiration or withdrawal. Medical Prevention Medications used to help prevent stroke in high-risk patients (especially those who have experienced a previous TIA or ischemic stroke) fall into two major categories. Stentriever devices are the newest generation of embolectomy devices for stroke. It was approved by the FDA in 2008.straight wire inside the small catheter pokes out beyond the clot and automatically coils into a corkscrew shape. the corkscrew spinning and grabbing the clot. They are still in an investigative phase. and block a smaller artery. Large numbers of platelets clump together to form a clot. anticoagulants and antiplatelet agents. but work by breaking up the occluding clot. which can sometimes block an artery or break loose. Platelets are specialized cells in the blood that initiate a healing process. CEA) Patients will be given either a general or local anesthetic before surgery. cutting off blood flow. Antiplatelet drugs make platelets less sticky and less likely to form clots. It is pulled back into the clot. A balloon inflates in the neck artery. In this procedure.

Carotid stenting is a neurointerventional procedure in which a tiny. especially in cigarette smokers. . The entire procedure usually takes about two hours. which helps to restore normal blood flow. There are potential complications with carotid endarterectomy surgery. and return to work. The stent is inserted following a procedure called angioplasty. There are several potential complications of endovascular treatment. Access is gained through a small (0. but uncommon.an incision in the carotid artery in the neck and removes the plaque using a dissecting tool. There is a 1 to 3 percent risk of stroke following surgery. just as there are with any type of surgery. usually within a month. newer form of treatment. The stent acts as scaffolding to prevent the artery from collapsing or from closing up again after the procedure is completed. The balloon is inflated and pressed against the plaque. This usually clears up in less than one month and most often does not require any treatment. This may occur later. in which the doctor guides a balloontipped catheter into the blocked artery. Carotid Angioplasty and Stenting An alternative. Another fairly rare complication is the reblockage of the carotid artery. slender metal-mesh tube is fitted inside the carotid artery to increase the flow of blood blocked by plaques.5 cm) groin incision and no incision is made in the neck. Patients should avoid driving and limit physical activities for a few weeks after surgery. The artery will be repaired with sutures or a graft. called restenosis. carotid angioplasty and stenting (CAS). One may experience pain near the incision in the neck and some difficulty swallowing during the first few days after surgery. This can block an artery in the brain. Most patients are able to go home after one or two days. caused by a disrupted plaque particle breaking free from the site. Numbness in the face or tongue caused by temporary nerve damage is a possibility. The most serious risk from carotid stenting is an embolism. shows some promise in patients who may be at too high risk to undergo surgery. flattening it and reopening the artery. Removing the plaque is accomplished by widening the passageway.

These risks are similar for CEA and CAS. Surgery/Clipping . Intensive care recovery for the next 10 to 14 days is the rule. Other complications include restenosis and short periods of medically treatable reduced blood pressure and heart rate. Hyperperfusion. and a small leg incision. The first 2 to 5 days after SAH represent the greatest threat of brain swelling. the risk period for delayed cerebral vasospasm begins. as opposed to 30 minutes for endarterectomy). and hydrocephalus may develop. Hemorrhagic Stroke Treatment Hemorrhagic stroke usually requires surgery to relieve intracranial (within the skull) pressure caused by bleeding. Surgery may be performed to seal off the defective blood vessel and redirect blood flow to other vessels that supply blood to the same region of the brain. There is also a slight risk of stroke due to a loose piece of plaque or a blood clot blocking an artery during or right after surgery. or the sudden increased blood flow through a previously blocked carotid artery and into the arteries of the brain can cause a hemorrhagic stroke. These risks are minimized using small filters called embolic protection devices in conjunction with angioplasty and stenting. For a patient with a ruptured cerebral aneurysm. cerebral angiography or a substitute study is done to document that the aneurysm has been eliminated. At some time during that period (often immediately upon completion of surgery). Near the end of this initial period. surgical elimination of the aneurysm is only the beginning. Intercurrent infections such as pneumonia are common. at which time special measures (both medical and surgical) are used to diminish the effect of swelling on intracranial pressure. during which time a multitude of complications related to SAH can and do occur. The risks are balanced against the advantages of a shorter occlusion time (10 seconds. and lasts the better part of the next 14 days.causing a stroke. Surgical treatment for hemorrhagic stroke caused by an aneurysm or defective blood vessel can prevent additional strokes. shorter anesthesia.

remain in place. In addition. Balloon-assisted coiling uses a tiny balloon catheter to help hold the coil in place. a thin wire filament or "coil" is advanced into the aneurysm. A smaller microcatheter is fed into the aneurysm. and once properly positioned. In endovascular microcoil embolization. and generally provide a durable cure for the patient. and a small catheter is inserted. platinum coil is designed to conform to the shape of the aneurysm. Additional coils are advanced into the aneurysm to close the aneurysm from the inside. and an anesthesia time that is often dramatically shorter than for craniotomy and microsurgical clipping. Clips are permanent. Angiography is used to confirm exclusion of the aneurysm from the cerebral circulation and the preservation of normal flow of blood in the brain. ongoing innovations in this relatively new technology has helped improve its efficacy. An operation to "clip" the aneurysm is performed by doing a craniotomy (opening the skull surgically). allowing it to deflate. Utilizing x-ray guidance. a needle is placed into the femoral artery of the leg. One or more tiny titanium clips with spring mechanisms are applied to the base of the aneurysm. The size and shape of the clips is selected based on the size and location of the aneurysm. a surgical procedure in which part of the skull is removed and left off temporarily.Prior to surgery. the exact location of the subarachnoid hemorrhage or aneursym is identified through cerebral angiography images. may be done to help relieve increased intracranial pressure. The flexible. Endovascular (Neurointerventional) Treatment Neurointerventional procedures for cerebral aneurysm share the advantages of no incision made in the skull. a craniectomy. the catheter is advanced through the body’s arterial system to one of the four blood vessels that feed the brain. This prevents flow of blood into the aneurysm by causing a clot to form on the inside. . and isolating the aneurysm from the normal bloodstream. Combination stent and coiling utilizes a small flexible cylindrical mesh tube that provides a scaffold for the coiling. Although this has been shown in several studies to increase risks.

heat) and may help patients regain the use of their arms and legs and prevent muscle stiffness in patients with permanent paralysis. urgical procedure appears to improve outcomes after bleeding stroke American Stroke Association Late-Breaking Science Report .. Feb. 7. preparing a meal.Abstract: LB1 . As a rule. speech therapy. HT. HT/ noon ET on Thursday.m.. Study Highlights: .Intracranial stenting and other innovations are quite new. In some cases. most strokes are associated with some recovery. and endovascular technology is in a constant state of development. Speech therapy may help patients regain the ability to speak. 7. Stroke News This news release is featured in a news conference at 7 a. getting dressed. and occupational therapy. Feb. and bathing).g. and provide excellent treatment alternatives for all forms of stroke and cerebrovascular disease. massage. These adjuncts allow coiling to be considered for cerebral aneurysms that may not have an ideal shape for conventional coiling. the extent of which is variable. Occupational therapy may help patients regain independent function and relearn basic skills (e.m..Embargoed until 7 a. These developments are timely. Neurointerventional treatments enable surgical procedures in the brain without the need to open the skull surgically. occurring in an era when stroke incidence is on the rise as the population ages. Stroke Rehabilitation Recovery and rehabilitation are among the most important aspects of stroke treatment. undamaged areas of the brain may be able to perform functions that were lost when the stroke occurred. Conclusion Modern treatments for ischemic and hemorrhagic stroke have reached an advanced state of development in the modern era of digital and device technology. Thursday. This news release contains updated numbers from the abstract. 2013 February 07. This type of recovery is measured in months to years    Physical therapy involves using exercise and other physical means (e. 2013 Categories: Scientific Conferences & Meetings.g. Rehabilitation includes physical therapy.

” said Hanley. said Daniel Hanley. it is removed through the catheter. . In one-year results of the Phase II study. which is medical management only. the advantage in the surgery group had increased to 14 percent. MISTIE (Minimally Invasive Surgery plus rtPA forIntracerebral Hemorrhage Evacuation). “There is now real hope we have a treatment for the last form of stroke that doesn’t have a treatment — brain hemorrhage. according to late-breaking research presented at the American Stroke Association’s International Stroke Conference 2013. “We believe we’re actually stopping brain injury and preserving brain tissue that would otherwise be lost. Next they apply the clot-busting drug recombinant tissue plasminogen activator (rtPA) to the clot via the catheter every eight hours for about three days. pushing it through the longest part of the clot. researchers found that patients treated with surgery and a clot. surgeons cut a hole the size of a dime in the patient’s skull. “The normal healing processes may be occurring more rapidly when you remove the blood. who is also director of the Brain Injury Outcomes Division at Johns Hopkins. The procedure removed 57 percent of the clots on average.” Hanley said. The stage two arm of the trial focused on 25 patients who had the surgical procedure and 31 who were given standard post-stroke medical care. As the clot liquefies. causing neurological damage. A catheter is passed into the brain tissue. researchers noted that the surgical group had 11 percent better functional outcomes. ICH is the most common type of bleeding stroke.busting drug had less disability. Patients were average age 60 and 75 percent were men. most are severely debilitated. which has formed from blood that pooled during the stroke.  If the findings are confirmed in a larger study. There is not a specific evidence-based targeted treatment recommended for ICH and there is no long-term randomized data on surgical treatment. spent less time in the hospital and were less likely to be in a long-term care facility than other ICH patients. Of the hundreds of thousands of Americans who have intracerebral hemorrhages (ICH) each year. 7.D. The overall study involved 96 patients at 26 hospitals who had a bleeding stroke. while clots naturally dissolved in only about 5 percent in the standard medical care group in the few days after stroke. Md. During the treatment. the surgery would be a major advance for treating hemorrhagic stroke.. It occurs when a weakened blood vessel inside the brain ruptures and leaks blood into surrounding brain tissue. lead author and professor of neurology at Johns Hopkins School of Medicine in Baltimore. 2013 – A minimally invasive procedure to remove blood clots in brain tissue after hemorrhagic stroke appears safe and may also reduce long-term disability. about the size of a golf ball. The study’s patients had blood clots with an average volume of 46 milliliters. M. HONOLULU. A minimally invasive surgery appears safe and may reduce long-term disability after a bleeding stroke. Hanley said. Feb.” Researchers found less fluid buildup (edema) in the brains of the surgical patients four days after the procedure. In six-month results presented last year. The newest findings showed that a year after the stroke. compared with the usual care group.

For patients who underwent the surgical procedure. . “then we have a practical treatment that can easily be done by all trained neurosurgeons. The association makes no representation or warranty as to their accuracy or reliability. And compared with the usual care group. The association receives funding primarily from individuals. Again. 14 percent fewer of the surgical patients were in long-term care a year later. blacks as well as whites. median time spent in any level of hospital or rehabilitation care was 38 days shorter than for the usual care group.000. and people over and under age 65 appeared to benefit equally. Alteplase®. If the MISTIE findings are confirmed. Revenues from pharmaceutical and device corporations are available atwww.” The study was completed as a cooperative program with Mario Zuccarello University of Cincinnati as the surgical leader and co-principle investigator. Genentech provided the rt-PA drug. the researchers estimated. yearlong results among patients with mild disability also showed a 14 percent difference between the treatment groups.org/corporatefunding. more patients from the surgical group improved during that time frame. although a larger study is needed to validate the findings.heart. device manufacturers and other companies) also make donations and fund specific association programs and events.” Hanley said.Likewise. That difference could represent a cost savings per patient of more than $44. The researchers hope next to conduct a 500-patient Phase III study at more than 75 sites. Hanley said the training for surgeons is simple and the equipment is readily available. #ISC13. The National Institute of Neurological Disorders and Stroke funded the research.” he said. Patients who had surgery between 36 and 72 hours after their stroke fared as well as those treated sooner. Statements and conclusions of study authors that are presented at American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. foundations and corporations (including pharmaceutical. The association has strict policies to prevent these relationships from influencing the science content. “It could make a substantial difference in this disease. “That 14 percent shift is occurring across the spectrum — from long-term care to moderate disability to mild disability. Follow news from ASA International Stroke Conference 2013 via Twitter @HeartNews. Women as well as men. Researchers noted that no hemorrhage was too large or too deep in the brain to be helped by the procedure. A full list of co-authors and author disclosures is available on the abstract.