Our Summary

This research paper looks at the best way to treat people who have carotid stenosis - a condition where the carotid arteries in the neck, which supply blood to the brain, become narrowed. This can increase the risk of stroke. The researchers focused on people who have this condition but don’t show any symptoms.

They reviewed guidelines and studies from 1993 to 2023, which compared two types of treatment: carotid endarterectomy (a surgical procedure that removes the narrowed part of the artery) and drug therapy.

The findings suggest that the best treatment can depend on the person’s age and the severity of their condition. For those under 75, carotid endarterectomy may be better, as it carries a small risk but can prevent potential strokes. For those with severe narrowing (80-99%), this surgery could also be the best option, as the risk of having a stroke is higher.

However, the authors note that the choice of treatment should be made individually, taking into account the doctor’s experience, and the patient’s willingness to adhere to the treatment and make necessary lifestyle changes.

The researchers also mention two upcoming studies (ACTRIS and CREST-2) that are expected to provide more clarity on this issue in the future.

FAQs

  1. What is carotid stenosis and how does it increase the risk of stroke?
  2. Based on the research, what factors determine the best treatment for carotid stenosis?
  3. What are the ACTRIS and CREST-2 studies and how are they expected to provide more clarity on the treatment of carotid stenosis?

Doctor’s Tip

One helpful tip a doctor might tell a patient about carotid endarterectomy is to closely follow post-operative care instructions, including taking prescribed medications, attending follow-up appointments, and making necessary lifestyle changes such as eating a healthy diet, exercising regularly, and quitting smoking. These steps can help reduce the risk of complications and improve the long-term success of the surgery.

Suitable For

Overall, patients who are typically recommended carotid endarterectomy are those who have carotid stenosis but do not show any symptoms, especially those who are under 75 years old and have severe narrowing of the carotid artery (80-99%). However, the decision on the best treatment option should be made on a case-by-case basis, considering factors such as age, severity of the condition, doctor’s experience, and patient’s willingness to adhere to treatment and lifestyle changes.

Timeline

Before carotid endarterectomy:

  1. Patient is diagnosed with carotid stenosis through imaging tests such as ultrasound or angiography.
  2. Patient may undergo medical management with medications to reduce the risk of stroke.
  3. Patient may experience symptoms such as transient ischemic attacks (TIAs) or mini-strokes.
  4. Patient and their healthcare team discuss the risks and benefits of carotid endarterectomy as a treatment option.

After carotid endarterectomy:

  1. Patient undergoes pre-operative evaluation and preparation for surgery.
  2. Patient undergoes carotid endarterectomy procedure, which involves removing the narrowed part of the carotid artery.
  3. Patient may stay in the hospital for monitoring and recovery post-surgery.
  4. Patient may experience some pain and discomfort at the incision site.
  5. Patient is closely monitored for any complications such as bleeding or infection.
  6. Patient is discharged from the hospital and continues with follow-up appointments with their healthcare team.
  7. Patient may need to make lifestyle changes such as quitting smoking, eating a healthy diet, and exercising regularly to reduce the risk of future strokes.
  8. Patient may be prescribed medications to manage blood pressure and cholesterol levels.
  9. Patient undergoes regular follow-up imaging tests to monitor the status of their carotid arteries.

What to Ask Your Doctor

Some questions a patient should ask their doctor about carotid endarterectomy include:

  1. What are the risks and benefits of carotid endarterectomy compared to drug therapy for my specific condition?
  2. How experienced are you in performing carotid endarterectomy procedures?
  3. What are the potential complications of carotid endarterectomy surgery?
  4. How long is the recovery process after carotid endarterectomy?
  5. Are there any lifestyle changes I need to make before or after the surgery?
  6. Are there any alternative treatments or procedures available for carotid stenosis?
  7. How often will I need follow-up appointments after the surgery?
  8. What is the success rate of carotid endarterectomy in preventing strokes?
  9. Will I need to take any medications after the surgery?
  10. Are there any specific factors about my health history that may affect the outcome of the surgery?

Reference

Authors: Korshunov DA, Kulbak VA, Chupin AV. Journal: Khirurgiia (Mosk). 2024;(3):45-53. doi: 10.17116/hirurgia202403145. PMID: 38477243