by admin-blog-kh | February 12, 2024 10:23 am
Stroke, also called Brain Stroke, is a serious condition. It can lead to lifelong disability and affect the patient’s quality of life, if not detected or treated on time. In most cases, stroke is treated after the event has occurred. However, if one is vigilant, and has an annual health checkup, the risks for stroke can be detected. That is when, various interventions can be done to prevent an occurrence or recurrence (another instance) of stroke. One of them is surgical procedures, and in this article, we will learn about the same.
Every part of the body requires a steady supply of oxygen-rich blood for proper functioning. The brain is the second largest internal organ in the human body (after the liver) and weighs around 1.5 kg. It is an important member of the Central Nervous System and controls just about everything that we do in our life. Needless to say, the human brain needs a constant supply of oxygen-rich blood.
Any disruption in this blood-flow can lead to serious consequences. Those areas of the brain which are served by the blood-vessels where there is disruption cannot function normally. This condition is called stroke[1]. If detected in the golden hour, and treated, the damage can be reversed. However, delays in providing emergency treatment can cause permanent disability. This includes paralysis or loss of function in one side of the body.
There are 3 types of Stroke:
Diagnosing the risk of stroke is done using CT scan, CTA scan, MRI scan, MRA scan and Doppler Sonography. Once diagnosed, medication can be given to flush out plaque deposits and blood clots. Diet and lifestyle changes can reduce the progression of atherosclerosis and even reverse it. In those cases, where medication, diet and lifestyle changes have not helped, or if the stroke risk was not even detected in the first place (due to health checkups not being done for long), a surgical intervention to is inevitable.
If the patient displays stroke symptoms suddenly, this should be treated as a stroke attack, and the patient must be rushed to a hospital immediately. Emergency treatment can reverse the stroke symptoms. If the golden hour has passed by and stroke symptoms have set in, surgical intervention is one of the treatment methods. Again, surgical intervention is of various types and includes:
Can stroke be prevented, or its risk reduced? Definitely yes! . Additionally, an annual health checkup will show signs of atherosclerosis and other vascular conditions. In such a case, the doctor may try medication depending on the severity of the condition. But in some case, he/she may decide that surgery is inevitable to prevent stroke. This primarily includes the below procedures:
CEA mentioned in the previous section can be done to both prevent a stroke attack and treat one, after an attack has occurred. This is an open-incisional procedure. As mentioned earlier, the carotid artery runs on both sides of the neck and supplies blood to the brain. Both the left, common-carotid-artery and the right, common-carotid-artery branch off from the aorta (main blood vessel taking oxygen-rich blood from the heart to rest of the body), travels through the chest into the neck, along the neck and enters the brain at its base.
Atherosclerosis can cause plaque deposits to block blood-flow in either of the carotid artery branches (right and left), or both in rare cases. Imaging scans can show where the blockage is and to what extent.
Once detected, the patient will have to undergo an open, incisional procedure under general anaesthesia. The surgeon will cut through the skin and other tissues in the neck, to access the carotid artery. Then, he/she will cut the artery and physically scrape off the plaque. Thereafter the artery and all the tissues above it are sutured up. The incision on the skin is stitched up. The wound will be cleaned regularly to prevent infection. The patient will stay in the hospital for a couple of days and once his/her vitals are stabilized, he/she will be discharged.
Some patients are not suitable for an open, incisional procedure like CEA. Age and existing health conditions can increase the risk of morbidity (illness) and mortality (death) when CEA is done on them. That is why, in such patients, a minimally invasive procedure such as balloon angioplasty with stenting is done to minimize the risk of stroke.
The procedure is very similar to what is done for coronary arteries in the heart. An endoscope is a thin, flexible tube that contains another tube running inside along its entire length, and carrying one or more instruments at its tip. A small cut is made on the groin and the endoscope inserted into a major artery there. The endoscope is gently pushed all the way to the concerned carotid artery (left or right).
Once the endoscope reaches the site of the blockage, a balloon located at the tip of the tube inside is inflated. This pushes the plaque deposits against the artery wall, thereby clearing the blockage. The balloon is enclosed in a wire-mesh called stent. After the balloon is deflated, the stent will stay there in place. It will prevent a repeat development of plaque deposits there (over time, the inner-lining tissue will grow around the stent and stabilize its position). Then the balloon is deflated and the endoscope slowly pulled out of the body.
The procedure is done under local anaesthesia[6] and the patient can be discharged the same day or the next day when his/her vitals have stabilized.
A stroke occurs when blood flow to a part of the brain is disrupted. Causes include blockages from blood clots (ischemic stroke) or bursting of blood vessels (hemorrhagic stroke).
Surgical procedures like carotid endarterectomy and carotid artery stenting can remove or bypass blockages in arteries, reducing the risk of strokes.
CEA is a surgical procedure where a surgeon removes plaque from the carotid artery in the neck to restore blood flow to the brain, preventing strokes.
CAS is a minimally invasive procedure where a stent is placed in the carotid artery to keep it open, improving blood flow and reducing stroke risk.
Strokes can be prevented by maintaining a healthy diet and lifestyle, undergoing regular health checkups, and managing conditions like atherosclerosis. In some cases, surgical procedures like carotid endarterectomy and stenting may be recommended to prevent stroke.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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