Which Stroke and Aneurysm Patients Can Safely Travel Abroad for Treatment?

Think of it like a blocked drainage system under a city. A surgeon's approach is to dig down from outside to reach the blockage. Our approach is to enter the drainage system from where it begins and navigate a map through the system to the blockage, clearing it from within — you don't have to dig the ground. Access is through a needle puncture in the groin or wrist, and from there the catheters track through the blood vessels all the way to the brain.

Age is not a criterion for us. We have treated patients in their 90s and even at 100 years of age and seen them recover. Age alone is never a reason to withhold intervention.

The key risk factors are hypertension and smoking. Blood hits the vessel wall repeatedly, the wall weakens and bulges into an aneurysm, and the body tries to repair itself — but if blood pressure is chronically elevated, or tobacco smoke is weakening the vessel wall, or there's an underlying genetic factor causing weak collagen, that repair mechanism gets overwhelmed and the aneurysm develops over time. This is different from AVMs, which are congenital and present from birth — aneurysms are acquired lesions that develop over a lifetime.

We're usually talking about narrowing at the carotid bifurcation in the neck, where the common carotid artery splits into the external carotid, supplying the face, and the internal carotid, supplying the brain. Stenosis of 50% or more on catheter angiography, or 60% or more on non-invasive imaging like CT or MR angiography, is considered significant and needs treatment. When we say severe stenosis, we mean 70% to 99% narrowing.

We work as a multidisciplinary team with a very respectful relationship with our neurosurgical colleagues. For aneurysms where both approaches are feasible, endovascular coiling is preferred under current guidelines, but we don't impose that on patients. We hold a multidisciplinary meeting, review the morphology together, discuss which endovascular option — coil, stent-assisted coil, or flow diversion — is most appropriate, and then meet the patient's family and explain the complexity, risk, and cost of each option in full so they can make an informed decision.

Because the stroke is actively evolving and brain damage is happening in real time, with a thrombolysis window of 4.5 hours and a mechanical thrombectomy window of 6 hours, extending to 24 hours only in selected imaging-positive cases. Acute stroke care cannot depend on a distant specialist centre, however good that centre may be.

Most travel for procedures such as intracranial angioplasty or carotid stenting, once the underlying vascular cause of a prior stroke has been identified and stabilised.

The aneurysm itself remains, described as a ticking bomb, since a second rupture is typically far more devastating than the first. These stabilised patients are the ones who travel for definitive aneurysm treatment.

An estimated 25 to 30 percent of patients are so severely affected by the initial bleed that they cannot even reach a hospital.