Hemorrhagic Stroke Treatment

Types of hemorrhagic stroke treatment

Endovascular coiling for treating hemorrhagic stroke

Endovascular coiling, also called coiling or endovascular embolization, is a procedure performed to block blood flow into an aneurysm (a weakened area in the wall of an artery). An aneurysm in the brain may be called a cerebral aneurysm, a brain aneurysm, or an intracranial aneurysm.

Preventing blood flow into an aneurysm helps to keep the aneurysm from rupturing (bursting). Coiling does not require a surgical procedure. Rather, a catheter (a long, thin tube) is inserted into an artery in the groin, then advanced into the affected artery in the brain. X-rays are used to guide the catheter into the artery.

Coiling may also be used to treat a condition called arteriovenous malformation, or AVM. An AVM is an abnormal connection between an artery and a vein that may occur in the brain, spinal cord, or elsewhere in the body.

The coils used in this procedure are made of soft platinum metal, and are shaped like a spring. These coils are very small and thin, ranging in size from about twice the width of a human hair (largest) to less than one hair's width (smallest).

Coiling is a newer procedure that has become available since the mid-1990s. Coiling has advantages over surgical aneurysm clipping because it does not involve opening the skull, and hospitalization time and recovery time are often shorter. However, not everyone with a cerebral aneurysm or AVM is a suitable candidate for a coiling procedure.

Brain aneurysm clipping

Aneurysms may be treated in different ways, depending on the type of aneurysm, where it is located in the brain, and the patient's medical condition. The standard method for treating a cerebral aneurysm is called aneurysm clipping. In this procedure, a small metal clip is used stop blood flow into the aneurysm, after an opening has been made in the skull to reach the aneurysm in the brain. The clip looks much like a clothespin. It is placed on the neck (opening) of the aneurysm to obstruct the flow of blood, and remains inside the brain.

Carotid endarterectomy

In a carotid endarterectomy, atherosclerotic plaque that has built up on the inside of the carotid artery wall is surgically removed. An incision is made on the side of the neck where the affected carotid artery is located. Under direct visualization, the artery is opened and the plaque removed. The artery is sutured back together, restoring normal blood flow to the brain. This procedure may be performed while a patient remains awake under local anesthesia or while the patient is asleep under general anesthesia.

Stereotactic radiosurgery

Radiosurgery works in the same manner as other types of therapeutic radiology. It distorts or destroys the DNA of tumor cells, causing them to be unable to reproduce and grow. The tumor will shrink in size over time. For blood vessel lesions, like an AVM, the blood vessels eventually close off after treatment.