Will I Need Surgery After a Stroke?

After you have a stroke -- when blood flow is cut off to an area of your brain -- your chances of having another one go up. You can make changes in your lifestyle to lower your risk, like eating well and quitting smoking.

And if you have certain medical conditions that make you more likely to have another stroke, your doctor can treat you for those. In some cases, that treatment may include surgery.

Why Might I Need Surgery After a Stroke?

An ischemic stroke is by far the most common kind. It happens when something blocks an artery that takes blood to your brain. Unhealthy arteries are one of the main causes of this type of stroke.

Over the years, cholesterol, fat, and other substances can build up and form fatty deposits called plaques in the walls of your arteries. This can make the arteries narrower and less flexible.

Sometimes the plaques break off. When that happens, clots can form that cut off blood flow, or pieces of plaque can break loose and travel through your bloodstream until they reach an artery that’s too small for them pass through.

Plaque buildup is especially dangerous when it’s inside your carotid arteries -- the ones that run on either side of your neck and bring your brain most of the blood it needs. If one of your carotid arteries is partly blocked, your doctor may recommend surgery to open it.

Who Should Have Surgery?

Your doctor will use imaging tests to look inside the artery and see how bad the blockage is. These tests might include:

  • A computerized tomography (CT) scan: Several X-rays are taken from different angles and put together to make a more complete picture.
  • A cerebral angiogram: Dye is put into the artery to make it show up on an X-ray.
  • An ultrasound: Soundwaves are used to make images of your artery.

If you’ve had a stroke or stroke symptoms and an artery is more than 50% blocked, surgery may help you.

But not everyone is healthy enough. If you had a major stroke and haven’t recovered, or if both of your carotid arteries are mostly blocked, the risks may outweigh the benefits. 

You also may not be a good candidate if you have: 

  • Serious heart problems, like heart failure or a recent heart attack
  • Uncontrolled high blood pressure
  • A major illness like kidney failure, diabetes, lung disease, or Alzheimer’s disease
  • Severe damage or blockage in other major arteries, like the ones that take blood to your heart
  • A new blockage in a spot where you’ve already had surgery
  • Advanced cancer 

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What Is a Carotid Endarterectomy?

This is the type of surgery used to open a partly blocked artery. A doctor called a vascular surgeon will make a small cut in your neck at the site of the blockage. Blood flow is rerouted through a tube or clamped off. The surgeon opens up the carotid artery and cleans out the plaque, then she’ll stitch it closed. She may need to patch it with a piece of fabric or a small piece of tissue from one of your veins. 

You might be put to sleep for the surgery, but it’s often done while you’re awake so the surgeon can watch for signs of problems. In that case, you’ll get medicine to make you relax and to block the pain. The surgery usually takes an hour or two. 

Like any procedure, a carotid endarterectomy has some risks. A stroke or heart attack can happen during the operation. It’s also possible to have nerve damage that affects the muscles in your mouth, throat, or face. 

What Is Recovery Like?

After a carotid endarterectomy, you’ll likely spend a couple of days in the hospital. Your neck may be sore and bruised for several days. Many people have trouble swallowing, and you may have to eat soft food for a while.

Once you’re home, you should take it easy until your doctor says you can go back to your normal activities. Driving may be hard until it doesn’t hurt to turn your head.

Your doctor may give you medicine to help with pain and keep your blood from clotting. It’s also important to control your blood pressure and cholesterol levels to keep your arteries healthy.

What Is Carotid Angioplasty?

If your doctor doesn’t think it’s a good idea for you to have surgery because of health issues, she may recommend this procedure to open your artery. She’ll put a small tube called a catheter into an artery in your leg or arm and send it up through your blood system to the carotid artery. Then she’ll blow up a tiny balloon at the end to make the artery wider. A device called a stent is usually left behind to hold the spot open and prevent future blockage.

You may be able to go home the same day, or you may need to spend a night in the hospital. 

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Other Types of Surgery

While doctors use carotid endarterectomy and angioplasty to prevent another stroke, other procedures can save your life while you’re having one. With an ischemic stroke, the goal is to get blood flowing again as quickly as possible.

The main treatment is a drug called tPA, which dissolves blood clots, but two procedures are sometimes also used:

  • Intra-arterial thrombolysis: Your doctor puts a catheter into an artery and guides it to the blockage. Then she’ll send medicine directly to the blood clot to dissolve it. 
  • Mechanical thrombectomy: Your doctor uses a catheter with a special wire cage on the end to grab the clot and pull it out.

A less common type of stroke, called a hemorrhagic stroke, happens when a blood vessel bursts either inside or on the surface of your brain. In that case, you might need one of these surgeries to stop the bleeding:

  • Coil embolization: Your doctor threads a catheter with a tiny coil at the end to the spot where the artery ruptured. The coil causes a blood clot to form, and that seals off the break.
  • Aneurysm clipping:  A hemorrhagic stroke is often caused by an aneurysm -- a weak spot in the artery wall that bulges out like a balloon and leaks or bursts. Your surgeon may put a clip at the base of the aneurysm to close it and prevent more damage.
  • Arteriovenous malformation (AVM) repair: An AVM is an abnormal growth of blood vessels. One of these also can burst or leak blood into your brain. You may need surgery to stop blood flow to the AVM or to take it out.
WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on July 14, 2017

Sources

SOURCES:

American Stroke Association: “Stroke Risks,” “Atherosclerosis and Stroke.”

American Heart Association: “Let’s Talk about Carotid Endarterectomy.”

National Heart, Lung, and Blood Institute: “Carotid Endarterectomy.”

Society for Vascular Surgery: “Carotid Endarterectomy.”

Texas Heart Institute: “Carotid Endarterectomy,” “Carotid Artery Angioplasty and Stents.”

American Association of Neurological Surgeons: “Carotid Endarterectomy and Stenosis.”

Yale School of Medicine: “Carotid Endarterectomy.”

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