Carotid endarterectomy - specific therapy based on pathophysiology

Article Abstract:

An article in the August 15, 1991 issue of The New England Journal of Medicine reports that carotid endarterectomy (removal of the diseased lining of a partially blocked carotid artery, which supplies blood to the brain) is safe and effective in preventing stroke (sudden loss of blood to part of the brain) in patients with symptoms and significant blockage (between 70 percent and 99 percent). The mechanisms by which narrowing caused by atherosclerosis (deposition of fatty plaque within arteries) results in stroke are described. The importance of the article is that the effectiveness of carotid endarterectomy is shown in a well-designed randomized study; previous studies yielded conflicting results. Studies are underway for patients with less severe narrowing (between 30 percent and 69 percent blockage). Such patients are at lower risk for stroke than those with greater amounts of narrowing. The implications of the study are that patients with high-grade carotid narrowing should be carefully screened for surgery. Medical treatments for patients who are not suitable candidates for surgery include aspirin and warfarin. Carotid endarterectomy should only be performed by highly skilled neurosurgeons and vascular surgeons. Whether surgery is appropriate for patients without symptoms remains to be determined; at present, it is not thought to be necessary even if narrowing can be detected. However, some asymptomatic patients will suffer major strokes. Both the severity and the effects on blood flow of carotid artery lesions need to be identified to determine a patient's risk of stroke. Two studies are in progress to compare surgical and medical approaches to carotid narrowing that may be serious, but causes no symptoms. Even when surgery clearly seems the best option, it should only be performed by medical teams with extensive experience. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Carotid artery, Carotid arteries, editorial

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Carotid endarterectomy revisited

Article Abstract:

It may be necessary to treat people with carotid artery stenosis surgically even if they have no symptoms. Carotid artery stenosis is a blockage in the carotid arteries, which supply blood to the brain. Decreased blood flow could cause a stroke. The surgical treatment of carotid artery stenosis is called endarterectomy. Studies have shown that endarterectomy only benefits patients with 70% or more blockage. However, even patients with less blockage may have abnormal blood flow in the artery that can predispose them to stroke.

Editorial

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Extracranial carotid stenosis

Article Abstract:

Patients with 70% or greater blockage in their carotid arteries who are experiencing symptoms from the blockage should have endarterectomy to reduce their risk of stroke. During endarterectomy, surgeons open the artery and remove the fatty deposits that cause the blockage. Patients with less blockage may not benefit from endarterectomy.

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