Experts at the Center for Endovascular Surgery specialize in the evaluation and treatment of strokes. Strokes fall into two categories:

1) Those disorders leading to ischemia, which is a lack of blood flow in the brain. Ischemic disease can be caused by stenosis (extracranial or intracranial), thrombosis or embolism.

2) Those disorders leading to hemorrhage, which is too much blood in the brain, such as brain hemorrhage or subarachnoid hemorrhage.

Factors that increase the risk for a stroke include:

• Age (people over 65 are at increased risk)
• Family or personal history of stroke
• Certain conditions like uncontrolled diabetes, high cholesterol and high blood pressure
• Smoking
• Lack of exercise
• Poor diet
• Obesity

Ischemic stroke often has no symptoms. In some cases, patients present with temporary stroke-like events called transient ischemic attacks (TIAs). Receiving treatment with tissue plasminogen-activator (tPA) at the first signs of a TIA or stroke may prevent brain damage if it is administered within three hours of the initial symptoms. Patients should seek immediate medical attention if they experience the following symptoms:

• Difficulty seeing
• Loss of strength, coordination or feeling on one side of the body
• Confusion
• Dizziness
• Seizures
• Severe headache similar to a migraine
• Slurred speech
• Difficulty eating or swallowing

Hemorrhagic stroke that results from a slow accumulation of blood can show early symptoms, including:

• Headaches
• Lethargy
• Nausea or vomiting

Hemorrhagic stroke that results from a blood vessel rupture presents with serious, immediate and life-threatening symptoms, including:

• A very severe headache that starts suddenly and is often located near the back of the head. Even if a patient is prone to headaches or migraines, this headache will feel very different from the normal pattern. It is often described as the “worst headache of your life.”
• Losing consciousness
• Inability to move or feel
• Confusion and irritability
• Muscle pain in neck and shoulders
• Nausea and vomiting
• Sensitivity to light
• Seizure
• Problems with vision
• Eyelid drooping
• Eye pupils are different sizes

 

If the physicians at the Center for Endovascular Surgery suspect a stroke, they will perform a thorough personal and family history and a medical examination. The Center's physicians will also perform additional tests that might include:

• Cerebral angiography. X-rays are taken of the brain after a dye is injected into it through a catheter threaded through the groin. Aneurysms are often seen on this X-ray.
• Carotid duplex ultrasound. Ultrasound technology provides images of the carotid arteries.
• A CT (computed topography) scan. CT scans can confirm hemorrhagic cerebrovascular disease.
• A lumbar puncture spinal tap. If the spinal fluid has traces of blood or is yellow signs this is an indication of bleeding in the brain.
• Magnetic resonance imaging (MRI). These scans can detect both blockages and aneurysms.
• Magnetic resonance angiography. This test can detect unruptured aneurysms and screen high-risk patients. Similar to cerebral angiography, images are taken of the brain after a dye is injected into it through a catheter threaded through the groin.
• Transcranial Doppler ultrasound, which is used to look at blood flow through the skull
• MR. NOVA, a computer program that calculates blood flow through magnetic resonance (MR) images and noninvasive optimal vessel analysis (NOVA)

Patients presenting with symptoms of hemorrhagic stroke that indicate a ruptured aneurysm are treated in a life-preserving way to stabilize their condition. The Center's physicians work closely with Emergency Departments of Beth Israel Medical Center in Manhattan, Beth Israel's Kings Highway Division in Brooklyn, and St. Luke's-Roosevelt Hospital Center to stabilize the patient.

Physicians at the Center for Endovascular Surgery treat hemorrhagic stroke by one or more of the following strategies:

• Locating the source of the bleed and then surgically clipping it.
• Placing a drainage device in the skull to decrease pressure in the brain.
• Follow-up care, which may require medications to reduce blood pressure, pain, anxiety, headaches and/or seizures.
  

Physicians at the Center for Endovascular Surgery treat ischemic stroke by one or more of the following strategies:

• Intravenous tPA (tissue plasminogen activator) may improve clinical outcome if a patient presents with stroke or TIA symptoms within three hours of onset of symptoms. Intravenous tPA is usually administered via the Emergency Department.
• Administering antiplatelet and anticoagulation agents
• Intra-arterial tPA
• Balloon angioplasty
• Extracranial and intracranial stenting
• Clot retraction with MERCI and PENUMBRA devices
• Bypass, including techniques using laser bypass technology
• Medications may be prescribed to reduce blood pressure, prevent embolism and/or control cholesterol
• Lifestyle changes may be recommended such as smoking cessation and nutritional and exercise counseling
• When a stroke has resulted in loss of function, physical therapy and stroke rehabilitation is recommended
• View our stroke centers