Stroke surgery: thrombectomy, hematoma removal, aneurysm clipping

Stroke surgery isn't a single method, but several different interventions used in distinct situations. For ischemic stroke, endovascular thrombectomy is more often used than open surgery: the doctor inserts a catheter through the vessel and mechanically removes the clot from the blocked artery in the brain. For hemorrhagic stroke, other interventions are possible: hematoma removal, external ventricular drainage, decompression surgery, or treatment of a ruptured aneurysm. [1]

The primary goal of stroke surgery is not to "cure the stroke completely," but to prevent brain tissue death, reduce intracranial pressure, stop recurrent bleeding, or reduce the risk of a new vascular event. Therefore, surgical treatment is always assessed based on a balance of benefits and risks: sometimes an intervention saves lives or reduces disability, while other times the risks of surgery outweigh the expected benefits. [2]

A decision about surgery cannot be made based solely on symptoms. Doctors consider the type of stroke, the time since symptom onset, CT scan, MRI, and vascular angiography data, the severity of neurological impairment, level of consciousness, age, previous independence, comorbidities, medications, blood clotting, and prognosis. This is why, if a stroke is suspected, urgent hospitalization at a stroke center is necessary rather than waiting at home. [3]

The 2026 Acute Ischemic Stroke Guidelines expanded the role of endovascular treatment in selected patients and emphasized the importance of appropriate routing: the patient must be transported quickly to a location where brain imaging, vascular assessment, thrombolytic therapy, and thrombectomy options are available. This is especially important in the case of a large artery occlusion, when every minute counts. [4]

In the case of a cerebral hemorrhage, the surgical logic is different: the physician does not remove the "clot from the vessel," but rather decides whether to relieve pressure, correct hydrocephalus, evacuate the hematoma, stop rebleeding, or transfer the patient to a neurosurgical center. The 2022 guidelines for spontaneous intracerebral hemorrhage emphasize the need for regional care systems with neurointensive care and neurosurgical capabilities when indicated. [5]

Type of intervention	For what type of stroke is it used?	The main goal
Endovascular thrombectomy	Ischemic stroke with occlusion of a large artery	Remove the clot and restore blood flow
Decompressive hemicraniectomy	Large cerebral infarction with dangerous edema	Reduce intracranial pressure
Removal of intracerebral hematoma	Isolated cases of hemorrhagic stroke	Reduce the volume of bleeding and pressure
External ventricular drainage	Hydrocephalus after hemorrhage	Drain cerebrospinal fluid
Clipping or endovascular treatment of aneurysm	Aneurysmal subarachnoid hemorrhage	Prevent recurrent aneurysm rupture
Carotid endarterectomy or stenting	Symptomatic carotid artery stenosis after transient ischemic attack or minor stroke	Reduce the risk of recurrent ischemic stroke

Endovascular thrombectomy for ischemic stroke

Endovascular thrombectomy is a minimally invasive procedure in which a blood clot is removed from a brain artery through a catheter. Access is typically gained through an artery in the groin or arm. Instruments are then advanced under X-ray guidance to the blocked brain artery and the clot is removed with a special device or by aspiration. The American Stroke Association describes this method as a procedure in which a catheter and device are used to remove a blood clot. [6]

Not all patients with ischemic stroke require thrombectomy. It is considered when there is confirmed blockage of a major artery, as these types of strokes often result in large lesions and severe disability. Computed tomography (CT) without contrast, computed tomography angiography (CT) or magnetic resonance angiography (MRA) are used for screening, and in later presentations, perfusion techniques are used to determine whether there is still salvageable brain tissue. [7]

The UK National Institute for Health and Care Excellence recommends performing thrombectomy as early as possible and within 6 hours of symptom onset in cases of confirmed proximal anterior circulation occlusion, if the procedure is appropriate based on clinical and imaging criteria. In some cases, thrombectomy is offered within 6 to 24 hours, including wake-up strokes, if imaging shows limited, established infarction and potentially salvageable tissue. [8]

In cases of posterior circulation involvement, such as the basilar or posterior cerebral artery, thrombectomy may also be considered within 24 hours in selected patients. This is particularly important because basilar artery occlusion can threaten consciousness, breathing, eye movement, swallowing, and vital functions. However, the decision depends on angiographic findings, perfusion assessment, severity of the condition, and overall prognosis. [9]

Thrombectomy does not preclude intravenous thrombolytic therapy if it is indicated and not contraindicated. When the time window is appropriate, physicians may combine thrombolytic therapy with thrombectomy, but intravenous therapy should not delay the patient's transition to mechanical clot removal. The 2026 update emphasizes a broader role for endovascular thrombectomy and expanded use of tenecteplase in the first 4.5 hours in eligible patients. [10]

Criteria for thrombectomy	What does it mean?	Why is it important?
Large artery occlusion	The thrombus is visible on angiography	It is these types of strokes that often have a severe course.
Time up to 6 hours	Early treatment window	The sooner blood flow is restored, the higher the chance of saving the brain.
Time 6-24 hours	Late window for selected patients	Visualization of potentially salvageable tissue is needed
A small, already formed lesion	The infarct core is not too large	Intervention may provide more benefits
Former independence	The patient was functionally independent before the stroke.	This is taken into account in the forecast.
Severity of neurological deficit	Assessed by a clinical scale	Helps select patients who really need the procedure

Decompressive hemicraniectomy for major stroke

Decompressive hemicraniectomy is a procedure that temporarily removes part of the skull bones to prevent the swollen brain from becoming compressed within the rigid cranium. This procedure does not restore dead brain tissue or remove the cause of ischemia, but it can be life-saving in cases of large infarction, particularly in the middle cerebral artery system, where swelling threatens to displace brain structures. [11]

The National Institute for Health and Care Excellence recommends considering decompressive hemicraniectomy within 48 hours of symptom onset in people with evidence of a large middle cerebral artery infarction. Criteria include significant neurological deficits, decreased level of consciousness, and evidence of an infarction of at least 50% of the middle cerebral artery territory on computed tomography (CT) or an infarction volume greater than 145 cubic centimeters on diffusion-weighted magnetic resonance imaging (DWI). [12]

The primary decision in such surgery is not technical, but ethical and prognostic. The surgery may reduce the risk of death, but a surviving patient may be left with severe disability, speech impairment, weakness on half of the body, dependence on care, and a long-term need for rehabilitation. Therefore, recommendations call for a discussion of the risks and benefits with the patient, if they are able to participate, or with family and caregivers, taking into account the individual's previous independence, values, and preferences. [13]

Following a hemicraniectomy, the patient requires neurointensive monitoring, swelling control, infection prevention, protection of the bone-free area, treatment of complications, and subsequent rehabilitation. Cranioplasty, which involves reconstruction of the cranial bone defect, is usually considered later once the patient's condition has stabilized. The timing depends on the infection, swelling, overall condition, neurological recovery, and local surgical protocols. [14]

It's important not to confuse decompressive hemicraniectomy with thrombectomy. Thrombectomy aims to restore blood flow and is performed through a vessel; hemicraniectomy aims to save life in cases of dangerous edema and is performed as an open neurosurgical procedure. Sometimes a patient may undergo thrombectomy first, and then, if a large infarction develops unfavorably, may require decompressive surgery, but these are different stages and have different treatment goals. [15]

Characteristic	Decompressive hemicraniectomy
The main goal	Reduce the fatal pressure on the swollen brain
Type of stroke	Most often, a major ischemic stroke occurs in the middle cerebral artery basin.
Optimal timing	Usually within 48 hours in suitable patients
What the operation does not do	Does not restore dead brain tissue
The main risk	Surviving with severe disability
What is required next?	Neurointensive monitoring, rehabilitation, possible cranioplasty

Surgeries for intracerebral hemorrhage

Surgery is not always necessary for intracerebral hemorrhage. Many hemorrhages are treated medically: blood pressure is controlled, anticoagulants are discontinued or reversed, consciousness is monitored, imaging is repeated, and edema and complications are treated. The National Institute for Health and Care Excellence indicates that small, deep hemorrhages, lobar hemorrhages without hydrocephalus or rapid deterioration, and some situations with severe underlying medical conditions are usually initially managed medically. [16]

Surgery is considered if the hemorrhage causes hydrocephalus, rapidly worsens, compresses vital structures, or dangerously increases intracranial pressure. Guidelines require that patients with intracerebral hemorrhage be monitored by neurosurgery or stroke specialists and, if worsening, promptly referred for repeat brain imaging. [17]

Hydrocephalus may require external ventricular drainage. This is a procedure in which a drain is placed into the ventricular system of the brain to drain cerebrospinal fluid and control pressure. The National Institute for Health and Care Excellence recommends that stroke services have agreed protocols for monitoring, referral, and transfer of patients with symptomatic hydrocephalus to regional neurosurgical centers. [18]

The 2022 guidelines for spontaneous intracerebral hemorrhage indicate that in patients with supraorbital hemorrhage, coma, a large hematoma with significant midline shift, or increased intracranial pressure refractory to medical therapy, decompressive craniectomy with or without hematoma evacuation may be considered to reduce mortality. However, the impact of such surgery on functional outcome remains uncertain, and this should be discussed with the family. [19]

Surgery for hemorrhage is particularly challenging because the brain tissue is already damaged by blood, and accessing the hematoma itself can cause further brain injury. Therefore, the doctor evaluates the location of the hematoma, its volume, level of consciousness, age, blood clotting, anticoagulants taken, the presence of hydrocephalus, prognosis, and the possibility of postoperative rehabilitation. There is no universal rule that "blood must always be removed." [20]

Situation during hemorrhage	Possible solution	Comment
Minor deep hemorrhage	Usually drug treatment	Surgery rarely improves outcome.
Lobar hemorrhage without worsening	Often initial observation and drug therapy	The decision depends on the dynamics
Hydrocephalus	Possible external ventricular drainage	Requires neurosurgical evaluation
Large hematoma with displacement	Possible decompressive surgery	May reduce mortality, but functional prognosis is uncertain
Hemorrhage due to warfarin	Urgent correction of coagulation	Prothrombin complex and vitamin K are used.
Rapid deterioration of consciousness	Repeat imaging and neurosurgical evaluation	May indicate hematoma growth or hydrocephalus

Surgery for aneurysmal subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage (ASH) is bleeding under the membranes of the brain from a ruptured aneurysm. It differs from a typical intracerebral hemorrhage in that the primary risk after an initial episode is recurrent rupture of the aneurysm, which dramatically increases the risk of death and severe disability. The 2023 guidelines from the American Heart Association and the American Stroke Association describe this condition as a severe and often fatal form of stroke that requires a specialized approach. [21]

The goal of surgery or endovascular intervention for a ruptured aneurysm is to "disconnect" the aneurysm from the bloodstream to prevent rebleeding. Two main approaches are used for this: microvascular clipping through open surgery or endovascular treatment, such as coil embolization. The choice depends on the aneurysm's shape, neck, location, patient age, brain function, presence of hydrocephalus, center experience, and the risk of the specific procedure. [22]

Current guidelines emphasize the need for rapid treatment of a ruptured aneurysm whenever possible, as rebleeding most often occurs early and is associated with poor outcomes. The 2023 guidelines recommend that aneurysms should be secured within 24 hours if the clinical situation and resources permit. [23]

Even after successful clipping or endovascular treatment, the risk remains. The patient remains under observation due to the risk of hydrocephalus, vasospasm, delayed cerebral ischemia, seizures, sodium imbalances, cardiac complications, and cognitive sequelae. Therefore, aneurysm treatment is only part of an overall neurointensive care program. [24]

Open surgery and endovascular techniques are not competing on the principle of "old" and "new." There are aneurysms where endovascular embolization is more suitable, and there are situations where clipping remains a more reliable option. In good practice, the decision is made by a multidisciplinary team: a neurosurgeon, an endovascular specialist, a neuroanesthesiologist, a neuroresuscitator, and a vascular neurologist. [25]

Method for aneurysm	How it is done	When might it be preferable?
Microvascular clipping	Open surgery with clip placement on the aneurysm neck	When anatomy is inconvenient for endovascular treatment
Endovascular coil embolization	Catheter filling of an aneurysm from the inside	With accessible anatomy and high risk of open surgery
Stent-assisted embolization	The coils are placed with the support of a stent.	In case of complex aneurysm neck, but risk assessment of antiplatelet agents is required
Flow-redirecting devices	Change the blood flow in the area of the aneurysm	Usually not a universal method in acute rupture
External ventricular drainage	Cerebrospinal fluid drainage	For hydrocephalus
Neurointensive observation	Control of complications after bleeding	Required even after aneurysm closure

Carotid surgery after stroke or transient ischemic attack

Carotid endarterectomy is a carotid artery surgery in which a surgeon removes atherosclerotic plaque from the inner lining of the vessel. It does not treat a stroke that has already occurred, but it can reduce the risk of recurrent ischemic stroke in people with symptomatic significant carotid artery stenosis, especially if the symptoms were on the same side of the artery. [26]

The National Institute for Health and Care Excellence recommends urgent referral for carotid endarterectomy evaluation in people with stable neurological symptoms following a minor stroke or transient ischemic attack (TIA) if they have symptomatic stenosis of 50–99% according to the North American Symptomatic Carotid Endarterectomy Study criteria or 70–99% according to the European Carotid Artery Surgery Study criteria. If the stenosis is less than these thresholds, surgery is not recommended, and best medical management is the primary treatment. [27]

The UK National Stroke Clinical Guidelines state that carotid endarterectomy should be the treatment of choice for symptomatic carotid artery stenosis, particularly in people aged 70 years and older or when the procedure is planned within 7 days of a stroke or transient ischemic attack. The patient must be neurologically stable and healthy enough for surgery. [28]

Carotid artery stenting is an alternative for some patients, but not a universal replacement for endarterectomy. National clinical guidelines note that, compared with surgical endarterectomy, endovascular treatment with stenting is associated with an increased risk of any stroke or death, although age and the specific clinical situation may modify the benefit-risk ratio.[29]

Carotid surgery should not be confused with thrombectomy. Thrombectomy is the emergency removal of a thrombus from a cerebral artery during acute stroke, while carotid endarterectomy is a prophylactic procedure after a minor stroke or transient ischemic attack with significant carotid artery stenosis. Sometimes a patient may require both approaches at different stages, but the goals and timing are different. [30]

Parameter	Carotid endarterectomy	Carotid artery stenting
Type of intervention	Open vascular surgery	Endovascular procedure
The main goal	Prevention of recurrent stroke	Prevention of recurrent stroke
Main group of patients	Symptomatic significant stenosis of the carotid artery	Selected patients based on age and anatomy
When it is especially useful	With stable symptoms and high stenosis	When open surgery is risky or anatomically complex
The main risk	Myocardial infarction, cranial nerve damage, stroke	Stroke around the procedure, restenosis, vascular complications
What is required along with the procedure?	The best drug treatment	The best drug treatment

Preparation, risks, and recovery after surgery

Preparation for stroke surgery almost always begins with rapid imaging. Doctors need to see what's happening in the brain and blood vessels: whether there's a hemorrhage, major artery occlusion, hydrocephalus, aneurysm, large infarction, displacement of brain structures, or carotid artery stenosis. The National Institute for Health and Care Excellence requires immediate CT without contrast when thrombolytic therapy or thrombectomy is indicated, and angiographic vascular assessment when thrombectomy is a possibility. [31]

Prior to the procedure, blood pressure, glucose, respiration, oxygen saturation, coagulation, anticoagulants, antiplatelet agents, renal function, allergies, level of consciousness, swallowing, and anesthesia risk are assessed. In cases of intracerebral hemorrhage during warfarin therapy, recommendations call for rapid restoration of coagulation using prothrombin complex and intravenous vitamin K; for direct oral anticoagulants, specific reversal approaches are used according to available protocols. [32]

Risks depend on the type of surgery. Thrombectomy can result in vessel damage, hemorrhage, embolism into another vessel, access complications, and unsuccessful recanalization. Hemicraniectomy can result in infection, bleeding, swelling, the need for repeat surgeries, and subsequent cranioplasty. Carotid endarterectomy can result in stroke, myocardial infarction, bleeding, cranial nerve damage, and restenosis. [33]

After surgery, the patient does not automatically "become healthy." They require monitoring in a stroke or neurointensive care unit, blood pressure and glucose monitoring, swallowing assessment, prevention of aspiration pneumonia, early safe mobilization, thrombosis prophylaxis, nutritional correction, monitoring of consciousness, and early rehabilitation. NICE recommends checking swallowing before meals, fluids, and medications, maintaining glucose in the range of 4-11 millimoles per liter, and assisting the patient to sit, stand, or walk when clinically appropriate. [34]

Post-surgical rehabilitation depends on the functions affected: movement, speech, swallowing, memory, vision, balance, self-care, or mood. Even a successful intervention does not eliminate the need for secondary prevention: monitoring blood pressure, lipids, diabetes, and heart rate, quitting smoking, treating atherosclerosis, and taking prescribed medications regularly. Without these measures, the risk of recurrent stroke remains high. [35]

Stage	What is being assessed?	Why is it important?
Before the intervention	Stroke type and imaging findings	Without this, it is impossible to choose a safe method.
Before anesthesia	Blood pressure, glucose, respiration, clotting, medications	Reduces the risk of complications
During the operation	Blood flow, pressure, access, bleeding	Determines technical success
The first day	Consciousness, speech, movement, pupils, pressure	Helps to quickly notice deterioration
The first days	Swallowing, nutrition, pneumonia, thrombosis, mobilization	Prevents early complications
After discharge	Rehabilitation and prevention of recurrent stroke	Determines long-term outcome

When surgery is not indicated or may be harmful

Stroke surgery is not performed "just in case." If the stroke is minor, there is no blockage of a major artery, no hydrocephalus, no dangerous edema, no significant carotid stenosis, or imaging shows a large, irreversible infarction with no salvageable tissue, intervention may be ineffective. In such situations, the best treatment is often drug therapy, stroke monitoring, and rehabilitation. [36]

Some patients with intracerebral hemorrhage rarely require surgical intervention initially. NICE classifies such situations as small, deep hemorrhages, lobar hemorrhages without hydrocephalus or rapid deterioration, large hemorrhages with significant preexisting conditions, extremely low levels of consciousness without hydrocephalus, and posterior fossa hemorrhages in certain circumstances. However, this does not preclude observation, as the course of the hemorrhage may change. [37]

In ischemic stroke, thrombectomy may be futile or dangerous if a large, irreversible infarction has already developed, if vascular occlusion is not confirmed, if preexisting functional dependence was severe, or if the patient's overall condition makes the intervention excessively risky. Therefore, recommendations require consideration of the overall clinical status and the extent of the existing infarction based on initial imaging. [38]

For carotid stenosis, surgery is not necessary if the stenosis is below the thresholds for proven benefit, or if symptoms are so unstable that the risk of surgery outweighs the benefit. NICE specifically states that if symptomatic stenosis is less than 50% according to the North American study criteria or less than 70% according to the European study criteria, surgery is not performed, and best medical treatment is used. [39]

The most dangerous mistake is to think that "surgery is stronger than pills" and therefore always better. In stroke, surgery is helpful only in situations where there is a specific anatomical or physiological goal: removing a clot, relieving pressure, draining fluid, closing an aneurysm, or correcting a dangerous stenosis. Without such a goal, surgery can increase the risk of bleeding, infection, vascular damage, anesthesia, and further disability. [40]

Why the operation may not be performed	What does this mean?
No major artery occlusion	Thrombectomy has no purpose
A large, already formed infarction	The amount of tissue that can be saved may be small
Minor deep hemorrhage	Open surgery often does not improve the outcome.
No hydrocephalus or rapid deterioration	Neurosurgical intervention may not be necessary
Carotid stenosis below the threshold of benefit	The operation has not proven beneficial
Severe concomitant diseases	The risks of intervention may outweigh the benefits

Frequently asked questions

Does everyone need stroke surgery?

No, surgery is only necessary for some patients. In ischemic stroke, it is considered in cases of blockage of a large artery, significant cerebral edema, or significant symptomatic carotid artery stenosis following a minor stroke or transient ischemic attack. In hemorrhagic stroke, surgery is possible in cases of hydrocephalus, dangerous compression, hematoma growth, or a ruptured aneurysm. [41]

How is thrombectomy different from thrombolytic therapy?

Thrombolytic therapy is the administration of a drug that dissolves the clot, while thrombectomy is the mechanical removal of the clot through a catheter. These methods can be combined if the patient is suitable based on timing, contraindications, and imaging data, but thrombectomy is especially important for large artery blockages. [42]

How long does it take to perform a thrombectomy?

Thrombectomy is typically offered as early as possible and within 6 hours of confirmed proximal anterior circulation occlusion. In selected patients, it may be performed within 6 to 24 hours if imaging reveals potentially salvageable brain tissue and limited infarct volume. [43]

What is decompressive hemicraniectomy?

This is a neurosurgical procedure that temporarily removes part of the skull bones to prevent the swollen brain from becoming compressed within the skull. It is considered for large infarctions in the middle cerebral artery system with severe deficits, decreased consciousness, and signs of extensive damage on imaging, usually within 48 hours. [44]

Is a hematoma always removed in case of hemorrhagic stroke?

No, not always. Small deep hemorrhages and some lobar hemorrhages without hydrocephalus or rapid deterioration are usually initially treated medically. Surgery is considered in cases of hydrocephalus, dangerous compression, decreased consciousness, a large hematoma, or persistently elevated intracranial pressure. [45]

What do they do when an aneurysm ruptures?

The goal of treatment is to secure the aneurysm as quickly as possible to reduce the risk of rebleeding. This can be achieved through microvascular clipping or endovascular treatment, such as coil embolization; the choice depends on the aneurysm's anatomy, the patient's condition, and the center's experience. [46]

Does carotid surgery treat a stroke that has already occurred?

No, carotid endarterectomy primarily reduces the risk of recurrent ischemic stroke in people with symptomatic, significant carotid artery stenosis. It does not restore already-dead brain tissue, so rehabilitation and better medical prophylaxis are still necessary afterward. [47]

What are the risks of stroke surgery?

Risks vary depending on the method: bleeding, recurrent stroke, vessel damage, infection, anesthesia complications, cerebral edema, thrombosis, swallowing difficulties, pneumonia, and the need for repeat procedures. Therefore, the decision is made after imaging, prognosis assessment, and a discussion of the benefits and risks with the patient or family. [48]

Key points from experts

Shyam Prabhakaran, MD, MS, FAHA, is chair of the 2026 Guidelines Task Force on Early Management of Acute Ischemic Stroke. His key message: the outcome of ischemic stroke depends on the speed and organization of care, including early recognition, appropriate routing, imaging, thrombolytic therapy, and endovascular thrombectomy in appropriate patients. [49]

Nestor R. Gonzalez, MD, MS, FAHA, is co-chair of the 2026 Acute Ischemic Stroke Guidelines. His research is particularly relevant to the topic of stroke surgery because endovascular thrombectomy changes the prognosis in some patients with large artery occlusion if performed promptly and with appropriate imaging criteria. [50]

Kori S. Zachrison, MD, MS, FAHA, is co-chair of the 2026 Acute Ischemic Stroke Guidelines. Her expert emphasis is on the system of care: surgery or an endovascular procedure is only beneficial when the patient is quickly transferred to a center with a trained team, imaging, routing, and the ability to intervene urgently. [51]

Steven M. Greenberg, MD, PhD, FAHA, is chair of the 2022 Spontaneous Intracerebral Hemorrhage Guidelines. The central message of this guideline is that, when hemorrhage occurs, surgery should be used selectively, and the system of care should provide neurointensive care, neurosurgical evaluation, correction of bleeding factors, and rehabilitation. [52]

Brian L. Hoh, MD, MBA, FAHA, is chair of the 2023 ASA Guideline for Aneurysmal Subarachnoid Hemorrhage. His key clinical message is that a ruptured aneurysm requires prompt, specialized treatment because rebleeding, hydrocephalus, vasospasm, and delayed ischemia determine mortality and long-term disability. [53]

Result

Stroke surgery is not a one-size-fits-all treatment, but a targeted tool for specific, dangerous situations: removing a blood clot from a large artery, relieving fatal pressure on the brain, draining cerebrospinal fluid from hydrocephalus, closing a ruptured aneurysm, or reducing the risk of a recurrent stroke from significant carotid artery stenosis. [54]

In ischemic stroke, the most important modern intervention is endovascular thrombectomy in appropriately selected patients; in cases of large cerebral infarction with dangerous edema, decompressive hemicraniectomy may be necessary. In hemorrhagic stroke, surgical decisions are related to the hematoma, hydrocephalus, increased intracranial pressure, and the cause of bleeding. [55]

The key practical point is simple: stroke surgery cannot be "scheduled at home" and cannot be chosen based on the symptom. It requires urgent hospitalization, brain and vascular imaging, assessment by the stroke and neurosurgical teams, a discussion of the benefits and risks, and post-surgery rehabilitation and prevention of recurrent stroke. [56]