When surgery is being considered after a stroke, your age, prior overall health, and current condition are major factors in the decision. Surgery is not recommended as part of the initial or emergency treatment for ischemic stroke.¹

Your doctor may perform:

• Carotid endarterectomy. Carotid endarterectomy is surgery to remove plaque buildup in the carotid arteries in people with moderate to severe narrowing of the carotid arteries. This surgery can help prevent additional strokes. For more information, see:

  Should I have carotid endarterectomy?

• Surgery to drain or remove blood in or around the brain that was caused by a bleeding blood vessel (hemorrhagic stroke).
• A procedure (endovascular coil embolization) to repair a brain aneurysm that is the cause of a hemorrhagic stroke. A small coil is inserted into the aneurysm to block it off. Whether this surgery can be done depends on the location of the aneurysm, its size, and whether you are healthy enough to withstand the procedure.
• Surgery to remove or block off abnormally formed blood vessels (arteriovenous malformations) that have caused bleeding in the brain. An arteriovenous malformation is a congenital disorder, which means it was present at birth. An arteriovenous malformation causes an abnormal web of blood vessels and veins in the brain, brain stem, or spinal cord. The vessel walls of an arteriovenous malformation may become weak and leak or rupture.

If a stroke has occurred because of a narrowed carotid artery, a carotid endarterectomy may help lower the risk of a future stroke.

Carotid endarterectomies are most successful when they are performed by a surgeon who is experienced in the procedure and in a hospital that is well equipped to take care of any complications that may occur during or after the procedure. Ask your doctor about his or her rate of complications and the complication rate at the hospital where the surgery will be done.

Carotid endarterectomy is not recommended:

• As an emergency treatment for people who have had a stroke caused by a clot (ischemic stroke).
• For people who are not expected to survive after their stroke.
• When the risks of surgery outweigh the benefits. A person may have medical problems that make surgery too risky, or a skilled surgeon may not be available.
• For people who have a transient ischemic attack (TIA) or stroke involving arteries in the back of the brain (vertebrobasilar arteries).
• For people who have minimal hardening and narrowing of the carotid arteries (less than 50% narrowing), even if they have had a transient ischemic attack (TIA). For these people, the surgical risks outweigh the benefits.
• For people with moderate hardening and narrowing of the carotid arteries (50% to 69% narrowing). The benefit of surgery for these people is still under investigation.

People with a brain aneurysm need evaluation of all their symptoms to determine whether and when surgery is needed. Endovascular coil embolization is the preferred treatment for people with a brain aneurysm. It is also used for those who are at high risk for complications from a surgical repair of the aneurysm.¹⁶ In cases where endovascular coil embolization is not possible, aneurysm clipping with craniotomy is done.