How to treat strokes

How can strokes be treated? Renowned vascular surgeon Prof. Dr. Hardy Schumacher of the Hirslanden Private Clinic in Zurich shares his expert knowledge about preventing and treating strokes.

We asked renowned vascular surgeon Prof. Dr. Hardy Schumacher of the Hirslanden Clinic in Zurich for an explanation of how strokes happen, what the treatment options are and what can be done to prevent them.

Minimising the damage

Patients who have experienced a minor or major stroke can be referred by a neurologist to a vascular surgeon.

Typically, 3 out of 10 of these patients have an instable plaque inside a blood vessel that is obstructing the flow of blood through the arteries that supply the head.

This blockage is the major cause for their stroke. This plaque with local thrombosis can cause a further stroke by cerebral embolisation.

It is very important that surgical treatment is carried out within 48 hours of the stroke or TIA (a mini-stroke) or before the onset of a stroke in case of high grade stenosis

Vascular surgeons have several options to remove the danger that plaque presents. Ultrasound screening for carotid stenosis is essential when any symptoms appear.

All patients should be offered a consultation about the best option available to them based on their medical history and preference.

Drug therapy

Drug therapy can be used to optimise a patient‘s risk profile. This approach supports invasive surgery in those patients.

The patient can be prescribed drug therapy for hypertension, diabetes or high cholesterol and get antiplatelet therapy avoiding clot formation at the plaque site.

It is very important that surgical treatment is carried out within 48 hours of the stroke or TIA.

Prof. Dr. H. Schumacher

Minimal invasive open surgery

Patients who have dangerous plaques in their carotid arteries are at high risk of stroke. Plaque is made up of fat, cholesterol, calcium, and inflammatory cells found in the bloodstream.

Over time, plaque narrows the carotid arteries and tends to get instable at the surface, with local rupture exposing the atheroma to circulation.

Only open surgery can completely remove that plaque and is considered an aversion technique: the artery is cut out of the bifurcation, plaque is removed and the carotid bifurcation is reconstructed by reinserting the artery using a running suture to avoid graft material.

Endovascular approach

Modern options also include a form of endoluminal technique that was designed to access many regions of the body via major blood vessels.

The problem is solved from inside the body using stents inside the carotid artery to widen the artery and improve blood flow. This is technically challenging but can be helpful in selected cases.

About Prof. Dr. Schumacher

Prof. Dr. Schumacher is a vascular surgeon at Hirslanden Private Clinic in Zurich. He is a renowned expert on open and endovascular surgery with experience of more than 1000 carotid operations and was one of the pioneers of minimal invasive surgery for treating aortic aneurysms.
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