Stroke

As a leading cause of death and disability in patients across the world, stroke is a problem that plagues both neurosurgeons and neurologists alike. Stroke affects more than 750,000 persons in the United States each year. A stroke is caused by blockage of blood flow to the brain, or by bleeding into the brain itself. The most common type of stroke is due to a blockage, which may be the result of a clot forming in the brain, or one that has traveled from another part of the body, such as the neck or the heart. There are a number of risk factors that can lead to stroke, including hypertension, smoking, elevated levels of cholesterol, diabetes, homocysteine, heart disease, and carotid artery disease.

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. A newer surgical procedure for carotid stenosis, called stenting, 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.

Extracranial-to-intracranial (EC/IC) bypass surgery is generally not recommended for patients with transient ischemic attacks. However, research is ongoing to determine whether there may be a subgroup of patients who might benefit from this treatment.