Cerebrovascular disease includes stroke, atherosclerosis of blood vessels supplying the brain, aneurysms and vascular malformations. Restrictions in blood flow may occur from vessel narrowing (stenosis), clot formation (thrombosis), blockage (embolism) or blood vessel rupture (haemorrhage). Treatment of these conditions requires timely intervention and multispeciality care involving the neurosurgeons, neurologist, neuroanaesthesiologist and neuroradiologist.
Stroke is an abrupt interruption of constant blood flow to the brain that causes loss of neurological function. The interruption of blood flow can be caused by a blockage, leading to the more common ischemic stroke, or by bleeding in the brain
Ischemic stroke occurs when there is a block in the blood vessel, which needs to be removed as early as possible to restore blood supply to the brain to prevent long term complications. Clots can be removed either by injection of medicines or mechanically by clot retrievers. If a patient presents late and the brain is irreversibly damaged then in some occasion’s patient may need decompressive craniectomy, where part of the skull is removed and kept in the abdomen to allow the brain to adapt to the enormous swelling that occurs which can be life threatening.
Haemorrhagic stroke can be caused by hypertension, rupture of an aneurysm or vascular malformation or as a complication of anticoagulation medications. Clots when large, must be removed when causing a threat to life. Bleeding caused by aneurysms and other vascular formations needs treatment for the primary condition to prevent re bleeds.
Blood vessels supplying the brain can sometimes get partially or fully blocked due to accumulation of plaques composed of fat and cholesterol. When symptomatic clots may be removed either surgically which requires the opening of the carotid artery under a controlled condition and manually removing the clot completely, the safety of this procedure can be enhanced by the use of neuromonitoring devices. Endovascular procedures can also be considered in certain patients wherein the plaques can be stabilised using stents by the endovascular route. At Aster, we have the most advanced and latest hybrid OT biplanar Cath lab, by which the endovascular procedures can be performed by the ease.
Cerebral Aneurysm and vascular malformations:
A cerebral (or cranial) aneurysm or vascular malformation when ruptures cause bleeding in the brain. This condition needs expert care by a multispecialty team, comprising neurosurgeons, neuroanaesthesiologist, neuroradiologist and intensivist for optimal care. These conditions may either require surgery or can be managed by endovascular techniques. Surgery generally involves securing the neck of the aneurysm by clips to prevent them from rebleeding.