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Stroke - Surgery

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of stroke.

Alternative Names

Transient ischemic attack; TIA

Surgery:

Carotid Endarterectomy

Carotid endarterectomy is a surgical procedure that cleans out plaque and opens up the narrowed carotid arteries in the neck. It is recommended to prevent ischemic stroke in some patients who have carotid artery stenosis of 70% or more. For people whose carotid arteries are narrowed by 50% or less, anti-clotting medications (antiplatelets and anticoagulants) are usually recommended in place of surgery. For patients with moderate stenosis (50 - 69%), the decision to perform surgery needs to be determined on an individual basis.

There is a risk of a heart attack or stroke from the procedure. Anyone undergoing this procedure should be sure their surgeon is experienced in performing this procedure and that the medical center has complication rates of less than 6%. Carotid endarterectomy is generally not recommended for patients with acute stroke.

Procedure Description. A carotid endarterectomy involves:

The patient is usually given general anesthesia, although a local anesthetic is sometimes used.
The surgeon cuts open the carotid artery and scrapes away the plaque on the arterial wall.
The artery is sewn back together, and blood flow is restored.
The patient generally stays in the hospital for about 1 - 2 days.
There is often a slight aching in the neck for about 2 weeks, and the patient should refrain as much as possible from turning the head during this period. Patients may experience a loss of sensation in the neck area, which will go away within a few months.

Endarterectomy is a surgical procedure that removes plaque material from the lining of an artery.

Carotid artery surgery - series
Click the icon to see an illustrated series detailing surgery for unblocking carotid arteries.

Carotid Angioplasty and Stenting

Carotid angioplasty and stenting (CAS) may be used as an alternative to carotid endarterectomy for some patients It is based on the same principles as angiography done for heart disease.

An extremely thin catheter tube is inserted into an artery in the groin.
It is threaded through the circulatory system until it reaches the blocked area in the carotid artery.
The doctor either breaks up the clot or inflates a tiny balloon against the blood vessel walls (angioplasty).
After temporarily inflating the balloon, the doctor typically leaves a circular wire mesh (stent) inside the vessel to keep it open.

This procedure carries a risk for an embolic stroke and other complications. At this time, it is being used in some centers as an alternative to endarterectomy in patients who cannot undergo endarterectomy, especially for patients with severe stenosis (blockage greater than 70%) and high surgical risk.

Resources

www.strokeassociation.org -- American Stroke Association
www.americanheart.org -- American Heart Association
www.stroke.org -- National Stroke Association
www.ninds.nih.gov -- National Institute of Neurological Disorders and Stroke
www.aphasia.org -- National Aphasia Association
www.aan.com -- American Academy of Neurology
www.strokecenter.org/trials -- Stroke Trials Directory

References

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Reviewed last on: 5/21/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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