Surgery is an accepted way of preventing stroke for patients with certain conditions. There are a number of conventional surgical techniques that have been in use for some time, including "clipping" aneurysms to prevent further bleeding and removing AVMs.
The KIMS Stroke Clinic is pioneering several new surgical techniques for patients with AVMs or aneurysms once considered impossible to treat because of their location or size.
Carotid endarterectomy is a procedure used to remove atherosclerotic plaque from the carotid artery when this vessel is blocked. It has recently been proven that for certain patients with minor strokes or TIAs, carotid endarterectomy is highly beneficial in preventing future strokes. This procedure is also beneficial for some patients with blockage of the carotid arteries who have not had previous symptoms.
Stereotactic Microsurgery for AVMs and Aneurysms
Stereotactic microsurgery is one of the most dramatic new surgical procedures for AVMs and certain aneurysms that were once considered untreatable. It employs sophisticated computer technology and geometric principles to pinpoint the precise location of the AVM. During the procedure, a custom-fitted frame is attached to the patient's head and three-dimensional reference points are established using CT or MRI. This technique allows neurosurgeons to locate the AVM within one or two millimeters so they can operate, using microscope-enhanced methods and delicate instruments, without affecting normal brain tissue.
Stereotactic Radiosurgery for AVMs
Stereotactic radiosurgery is a minimally invasive, relatively low-risk procedure, that uses the same basic techniques as stereotactic microsurgery to pinpoint the precise location of the AVM. Once located, the AVM can be obliterated by focusing a beam of radiation that causes it to clot and then disappear. Due to the precision of this technique, normal brain tissue usually is not affected. This procedure is generally performed on an outpatient basis.
During surgical treatment of aneurysms and AVMs, there is a certain inherent risk that the patient may have a stroke while on the operating table. KIMS physicians are using a technique known as hypothermia (cooling of the body), to prevent stroke during surgical treatment of giant and complex aneurysms or difficult AVMs. Dropping the brain temperature gives the surgeon the necessary time to operate with minimal risk of surgery-induced stroke. Special equipment known as a cardiopulmonary bypass machine is sometimes used to completely shunt blood flow away from the brain while the body is placed under deep hypothermia.
Revascularization of the Blood Supply
Revascularization is a surgical technique for treating aneurysms or blocked cerebral arteries. The technique essentially provides a new route of blood to the brain by grafting another vessel to a cerebral artery or providing a new source of blood flow to the brain. KIMS has been at the forefront of advances in revascularization techniques. In addition to new medications and surgical techniques, The KIMS Stroke Clinic is pioneering a number of new interventional radiology procedures to prevent stroke in patients with selected high-risk AVMs, aneurysms, and partially blocked arteries. These endovascular procedures are performed within the blood vessel.
Endovascular Treatment of Aneurysms
Endovascular treatment of aneurysms is a new interventional neuroradiologic technique, which greatly benefits patients with serious medical conditions who are unable to sustain the stress of surgery. Platinum coils developed at KIMS are guided into the aneurysm via a catheter, creating a clot that effectively closes the aneurysm off from the surrounding circulation, preventing the risk of hemorrhagic stroke in the future.
Endovascular Treatment of AVMs
Endovascular treatment of AVMs is also available at KIMS. One innovative form of treatment involves use of a "super glue" substance introduced via a tiny catheter to reduce the size of the AVM and facilitate further microsurgical or radiation treatment. In some cases, it is possible to completely block off and cure the AVM with endovascular treatment alone.
Angioplasty and Stenting of Vessels in the Neck and Brain
Angioplasty and stenting of vessels in the neck and brain are other new endovascular procedures available at only a few institutions nationwide. Cerebral angioplasty is similar to a widely used cardiology procedure, and is used to open partially blocked vertebral and carotid arteries in the neck, as well as blood vessels within the brain. Stenting of carotid or vertebral arteries and large cerebral veins involves use of a fine, tubular wire mesh to hold the vessel open.