Accident vasculaire cérébral ischémique

An ischemic stroke happens when a blood vessel to the brain is blocked by a clot or buildup inside the vessel, cutting off blood and oxygen so brain cells start to die within minutes. It is a medical emergency, but fast treatment can limit brain damage and greatly improve the chance of recovery.

1) What is this condition?

A clot or narrowing blocks blood flow to part of the brain, so that area cannot get enough oxygen and nutrients.
It is the most common type of stroke (about 80–85% of all strokes).
Symptoms usually start suddenly: face drooping, arm weakness, speech trouble, vision loss, trouble walking, or severe confusion.

2) How serious is it?

Without quick treatment, an ischemic stroke can cause permanent disability or death.
The amount of damage depends on which artery is blocked, how large the area is, and how soon blood flow is restored.
Even milder strokes can leave lasting problems with strength, balance, language, thinking, or mood.

3) Non‑surgical treatments

Emergency “clot‑busting” medicine (IV tPA/alteplase or similar) within about 4.5 hours of symptom start to dissolve the clot and reopen the vessel.
Blood‑thinning medicines (like aspirin and, in some cases, other antiplatelets or anticoagulants) to prevent new clots.
Care in a dedicated stroke or intensive unit to control blood pressure, blood sugar, fever, and protect the airway and breathing.
Early, structured rehabilitation (physical, occupational, speech therapy) started within days to improve walking, arm use, self‑care, and thinking.

4) Types of surgery/procedures that may be needed

Mechanical thrombectomy: a catheter is threaded through an artery (usually from the groin or wrist) up to the brain to grab and remove a large clot.
Procedures to open or clean out neck arteries that are badly narrowed (carotid endarterectomy or carotid artery stenting) to reduce future stroke risk.
For large territory strokes with brain compression and brain shift, open surgery may be offered. This surgery, called decompressive craniectomy, removes the skull on the affected side, to relieve pressure. The skull bone is kept in tissue refrigeration and will be placed back (cranioplasty) once the brain is relaxed a few months later.

5) Goals of surgery vs non‑surgical care

Non‑surgical goals:
- Quickly restore or improve blood flow using clot‑dissolving medicines when safe.
- Prevent new clots, protect the brain from complications, and begin rehabilitation to regain function.
Surgical/procedural goals:
- Physically remove large clots that medicine alone cannot reliably clear.
- Fix or widen significant vessel narrowings to lower the chance of another stroke.
- Physically remove skull bone overlying the stroke areas, to avoid pressure build up around vital brain parts.

6) How surgery/procedures can “fix” the problem

Thrombectomy devices act like tiny stent‑retrievers or suction tools to pull or suck the clot out, allowing blood to flow again to the threatened brain area.
Carotid surgery removes fatty plaque from the neck artery, and stents hold arteries open so blood can pass more smoothly to the brain.
Decompressive craniectomy reduces pressure and facilitates survival.

7) Risks of surgery (general and specific)

General risks: bleeding, infection, reactions to contrast dye, and complications from anesthesia or sedation.
Thrombectomy‑specific: bleeding into the brain (hemorrhagic transformation), damage to the vessel, or a piece of clot breaking off and blocking another area.
Carotid procedures: stroke during the procedure, nerve injury in the neck, or re‑narrowing of the artery later.
Cranial procedures: Bleeding, infection, trouble with wound healing. Need for re-implantation of the removed skull bone.

8) Chances these treatments will work

IV clot‑busting medicine improves the chance of a good recovery when given quickly; many treated patients are more likely to walk and live independently.
For large‑vessel blockages, combining thrombectomy with clot‑busting medicine roughly doubles the chance of living independently compared with medicine alone (around 50% vs about one‑third).
For large territory strokes, open surgery may help reduce chances of death, but will not restore function to the brain structures damaged by the stroke.
Results are best the earlier treatment is started and in people with smaller areas of already‑dead brain.

9) Possible complications from treatments

Bleeding into the brain after clot‑busting medicine or thrombectomy, which can worsen symptoms or be fatal.
Swelling of the damaged brain area, seizures, infections, or clots in the legs or lungs from being less mobile.
Mood disorders, memory problems, and fatigue that can persist and need long‑term management.
Open surgery – problems with wound healing, need for surgery a few months later to place the skull back (cranioplasty).

10) Typical recovery from the condition

Recovery is highly individual; some people have near‑complete recovery, others have mild, moderate, or severe disability.
Many improvements occur in the first 3 months, but gains can continue for a year or longer with good rehabilitation.
Early, coordinated rehab (within the first 2 weeks) is associated with better movement, independence, and quality of life.

11) Typical recovery after procedures

After thrombectomy, patients usually stay in a stroke unit or ICU for at least 24 hours for close monitoring, then move to a regular floor or rehab.
Strength, speech, and thinking may improve quickly if blood flow was restored early, but formal therapy is usually still needed.
After carotid surgery or stenting (done later to prevent new strokes), most people resume normal light activities within days to a couple of weeks.
Decompressive craniectomy patients have a prolonged, and usually incomplete, recovery because of the large territory brain tissue loss and swelling that needed skull removal surgery in the first place.

12) How long in the hospital

Many ischemic stroke patients stay 3–7 days, depending on stroke severity, need for procedures, and medical complications.
More severe strokes or those needing intensive rehab may stay longer in acute care, then move to an inpatient rehab facility.

13) Long‑term outlook

About half of survivors regain independence in basic daily activities, but many have some lasting weakness, speech, or thinking changes.
Risk of another stroke is higher than average, especially without strong control of blood pressure, cholesterol, diabetes, smoking, and heart rhythm problems.
With good risk‑factor control, medicines, and follow‑up, many people live for years with a good quality of life.

14) Need for outpatient follow‑up

Regular visits with a stroke specialist or neurologist and primary doctor to adjust medicines (blood thinners, blood pressure, cholesterol, diabetes drugs).
Ongoing physical, occupational, and speech therapy as needed, plus driving/work evaluations when appropriate.
Monitoring and support for depression, anxiety, thinking problems, and caregiver stress are key parts of long‑term care.