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Stroke Care Center at the Gates Vascular Institute
Surgical Endovascular Management of Ischemic Stroke

Endovascular (within the blood vessels) surgery is used in appropriate patients to treat strokes by improving blood flow to the brain. All procedures listed below are targeted to restore flow at the site of the blockage.

Percutaneous Transluminal Angioplasty (PTA)

This minimally invasive procedure involves the placement of a catheter that begins at the groin and is threaded into an artery of the neck and head. During the procedure, a catheter with a balloon tip is inflated resulting in the compression of the blockage against the arterial wall, which reestablishes the flow of blood.

Intraarterial Thrombolysis

Intraarterial thrombolysis is used in carefully selected patients with acute ischemic stroke caused by large cerebral (brain) vessel blockage. During the procedure, a cerebral angiogram identifies the blocked blood vessel after which the “clot buster” medication is injected into the clot. The medication breaks the clot into smaller pieces, which restores blood flow.

 

stents

Stenting

Stenting involves guiding a catheter into an artery, which carries a mesh wire called a stent. Once the stent reaches the area that is blocked, the mesh is expanded to open the narrowed artery in the neck (carotid artery) or in the brain, which restores blood flow.

 

Penumbra Catheter

Penumbra

In some patients, a penumbra catheter may be used to remove a large clot. The Penumbra System breaks up the clot and suctions it out of the blood vessel.

 

Mechanical Clot Retrieval

Mechanical Clot Retrieval

In select patients, the clot may be removed with a mechanical corkscrew device called the Merci Retriever.

 

Aneurysm

Endovascular Management of Subarachnoid Hemorrhage (SAH) Aneurysm

Coiling is a procedure in which a catheter is introduced through a major artery of the arm or leg. The catheter is guided up to the aneurysm (a weakened spot in the wall of the blood vessel), and a device called a coil is placed in the aneurysm to prevent it from rupturing.

 

Stent-assisted aneurysm coiling

Stent-Assisted Aneurysm Coiling

Sometimes a stent needs to be used to assist in keeping the coil inside the blood aneurysm.