Surgical treatment strategies in ischemic stroke

Although the most dramatic recent advances in the treatment of stroke have been medical in nature, there still remains a role for surgery in selected patients with cerebrovascular ischemic disorders. Direct revascularization procedures, including carotid endarterectomy and extracranial-intracranial bypass, remain important tools for the vascular neurosurgeon. Lastly, decompressive hemicraniectomy is being increasingly performed in patients with massive nondominant infarcts, as a means of salvaging individuals who otherwise would succumb to herniation. This article addresses the current indications, techniques, and results of the aforementioned techniques for the surgical treatment of ischemic stroke.