Patients who have experienced stroke or a transient ischemic attach (TIA) are at significant risk for another stroke. In many cases, a TIA is a warning sign that a true stroke may happen in the future if something is not done to prevent it.
“Preventive surgery can reduce the risk of a future stroke 9 to 26 percent a year,” says William Thorell, MD, neurosurgeon at The Nebraska Medical Center.
“Now physicians have two safe and effective options for treating carotid artery disease, the traditional carotid revascularization endarterectomy or carotid stenting,” says Dr. Thorell. “In the past, endarterectomy was thought to be the preferred procedure. However, recent evidence produced by the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) revealed similar results in patients for the treatment of carotid stenosis.” Results were published in the July 2010 issue of the New England Journal of Medicine.
“The morbidity and mortality are about equivalent for both at approximately 5 percent,” says Dr. Thorell. Complications include stroke, heart attack and death. In this particular trial, the death rate was extremely low, at just .3 to .7 percent.
A patient who presents with symptoms of a stroke or TIA, should undergo imaging in the cerebral vessels. This can be done with ultrasound, MRA or CTA.
If the scan reveals narrowing of the carotid arteries by 50 percent or more, the patient should be seen by a specialist to determine if he or she is a candidate for surgery. “We work as a team with our vascular surgery colleagues to determine which procedure is most appropriate for the patient,” says Dr. Thorell. “In certain situations, stenting is preferable to endarterectomy. This includes patients who have had previous radiation surgery to the head and neck, patients who have had a previous endarterectomy with recurring narrowing and patients with difficult anatomy for surgery.”
While many patients are prescribed drugs like statins, blood pressure medications and anti-platelet agents such as Aggrenox to reduce their risk of stroke, surgical treatment of severe blockages in the carotid artery has been shown to be more effective than medical therapy alone in preventing ischemic strokes caused by plaque buildup.
Stroke is the third leading cause of death and the number one cause of disability in adults, with 750,000 new strokes occurring each year.