Indications for carotid endarterectomy

Article Abstract:

The carotid arteries are the major blood vessels supplying the head and neck, and under abnormal conditions, they may become blocked, resulting in ischemia (insufficient blood supply). A prolonged ischemic attack may lead to stroke, the loss of consciousness followed by paralysis. Endarterectomy is the surgical removal of the lining of an artery, a procedure that may be used to reduce the incidence of stroke and transient ischemic attacks. The National Institutes of Health initiated three clinical trials to study the effectiveness of endarterectomy as compared with medical therapy such as with aspirin in preventing cerebrovascular disease in patients, both with and without symptoms. Because endarterectomy is done to prevent stroke, the risks of death and stroke resulting from the surgical procedure itself must be minimal to be able to consider the procedure beneficial. Although aspirin was shown to reduce the risk for ischemic stroke by 15 to 30 percent, patients with carotid artery stenosis, or narrowing, treated by endarterectomy had a lower incidence of death and stroke than patients treated by nonsurgical methods. The specific conditions under which endarterectomy should not be performed are described. Young people appear to benefit more from this surgical procedure than elderly patients. Results of the clinical trials should provide more information about the risks and benefits of endarterectomy in treating cerebrovascular disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Carotid artery diseases

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Carotid endarterectomy

Article Abstract:

The carotid arteries are the major blood vessels supplying the head and neck, and under abnormal conditions, they may become blocked, resulting in ischemia (an insufficient blood supply) and carotid artery disease. The usefulness of endarterectomy, the surgical removal of the lining of an artery, to prevent carotid artery disease was evaluated. Many studies have examined the course of untreated cerebrovascular disease, the effectiveness of aspirin in preventing ischemic attacks, and comparative effects of surgery in treating patients with symptoms of the disease. Studies have shown that fewer endarterectomies should be performed and with more precise indications. The incidence of complications, effectiveness of surgery, risk of stroke, the presence of other diseases, and results of X-rays on the affected blood vessels must all be taken into account when considering endarterectomy for preventing cerebrovascular disease. The acceptable mortality from surgery is less than one percent, whereas the incidence of stroke-related disease in patients with previous stroke is less than three percent. The rate of death due to surgery and incidence of stroke-related disease are less than two percent in patients with stenosis, or narrowing, of the carotid arteries but without symptoms. Thus, several factors should be considered when deciding whether endarterectomy should be performed to treat cerebrovascular disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Atrial fibrillation: restoration and maintenance of sinus rhythm and indications for anticoagulation therapy

Article Abstract:

Cardioversion appears to be the most widely used method for restoring the heart's normal sinus rhythm after atrial fibrillation. Cardioversion involves placing metal paddles on the chest to deliver an electrical shock. It can restore heart rhythm in 80% of patients with atrial fibrillation, which is a type of arrhythmia. The age of the patient and the severity of their arrhythmia determine the methods used for restoring and maintaining heart rhythm and whether anticoagulant drugs or longterm therapy should be ordered.

Care and treatment, Anticoagulants (Medicine), Anticoagulants, Atrial fibrillation, Electric countershock

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