Stroke is the generic name given to brain damage of vascular origin, either due to:
- Cerebral hemorrhage: caused by a malformation of the vessels that irrigate the brain or a rupture of the same due to high blood pressure. This type of lesion is treated by the interventional neuroradiologist and/or neurosurgeon.
- Ischemic lesion (infarction): caused by detachment of atheroma plaque or platelet aggregate or thrombus, originating in an arteriosclerotic lesion in the vessels supplying the brain, preferably in the carotid artery. They should be evaluated and treated by the vascular surgeon.
Ischemic stroke surgery
Surgery for ischemic stroke will consist, if the conditions and the brain lesion allow it, in the excision of the atheroma plaque or lesion originating in the diseased artery.
The surgical procedure, after neurological evaluation, should be performed within the first fifteen days following the stroke, and this should have been with recovery of the same to obtain maximum performance. It will be indicated in those lesions that have given symptoms such as transient strokes, momentary blindness, recovered stroke, etc. and that involve an obstruction of blood flow of more than 75% approximately. The evaluation of the lesion in the artery will be carried out by the vascular surgeon using minimally invasive techniques such as Echodeppler.
In the hands of an experienced surgeon, and with a required rate of absence of surgical complications below 3%, it is a safe technique that avoids recurrences, as long as the patient follows the indicated treatment and vascular risk factors are kept under control.
Stroke surgery with anterior approach to the spine
Given the intimate relationship of the anterior aspect of the spine with the great blood vessels (Aorta and Vena Cava), the presence of a vascular surgeon is required in the instrumentation and anterior fixations of the spine (when the possibilities by the posterior approach have been exhausted or to complement). It is essential in the intervention to gain safety and avoid massive bleeding due to a lack of expertise and practice on the part of the spine team, since the removal or dissection of the great vessels requires anatomical habit and knowledge as well as knowledge of the instruments used for this purpose.
In large surgical centers, the presence of the vascular surgeon provides safety to the procedure and is surgically required for good practice.