For people with hemorrhagic stroke, surgery may be needed. The first step is to pinpoint the cause of bleeding in the brain, then control it.
If a stroke is caused by a blockage in a carotid artery in the neck—which supplies blood to the brain—doctors may perform what’s known as a carotid endarterectomy. In this procedure, surgeons remove the buildup of plaque, a hard, waxy substance that contains cholesterol, fat, and calcium.
To perform carotid endarterectomy, a surgeon makes an incision along the side of the neck and locates the carotid artery. He or she opens the artery and removes the plaque, then closes it. This procedure is performed using local anesthesia, and people who have it typically stay in the hospital overnight for observation.
The cerebrovascular and vascular surgeons at NYU Langone are national leaders in this procedure. They perform more than 300 carotid endarterectomies per year.
If an aneurysm—a balloon-like bulge in an artery—is the cause of a stroke, a doctor may recommend aneurysm clipping or coil embolization. Aneurysm clipping is performed to prevent an aneurysm from rupturing or leaking blood into the brain. It also can help prevent an aneurysm from bursting a second time.
During this procedure, a surgeon makes an incision in the skull to expose the brain. He or she then makes a small incision in the brain and places a tiny clamp at the base of the aneurysm. This procedure is performed using general anesthesia, and most people stay in the hospital’s intensive care unit for a few days afterward.
Coil embolization is a less complex procedure. In this surgery, a doctor inserts a flexible tube called a catheter into an artery in the groin and threads the catheter to the site of the aneurysm. Then, the doctor pushes a tiny coil through the tube and into the aneurysm, causing a blood clot to form. This blood clot blocks blood flow through the aneurysm and prevents it from bursting again.
Coil embolization is performed using general anesthesia. Most people stay in the hospital for a few days after surgery.