Our Summary

This research paper is a review of previous studies that compared the effects of surgical treatment (carotid endarterectomy) plus medical treatment versus medical treatment alone on patients who have recently had a stroke or transient ischaemic attack (TIA) due to narrowed carotid arteries (stenosis). The carotid arteries supply blood to the brain, and if they are narrowed, it can increase the risk of stroke.

The review found that the benefit of surgery varied depending on the severity of the stenosis. For people with less than 30% stenosis, surgery increased the risk of stroke or death from surgery. For those with 30% to 49% stenosis, surgery had a small reduction in risk. For those with 50% to 69% stenosis, surgery showed some benefit, and for those with 70% to 99% stenosis, surgery was highly beneficial.

In essence, the research concludes that surgical intervention may reduce the risk of a recurrent stroke in people with significant carotid artery stenosis. The benefit of surgery seemed to be more evident in those with severe stenosis (70% to 99% narrowing). However, this medical procedure does carry the risk of complications. So, the decision to undergo surgery should be made after a thorough discussion with a medical professional about the potential benefits and risks.

FAQs

  1. What is carotid endarterectomy and who does it benefit?
  2. How does the severity of carotid artery stenosis affect the benefits of undergoing a carotid endarterectomy?
  3. What are the potential risks and complications of carotid endarterectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about carotid endarterectomy is to carefully follow post-operative instructions, including taking prescribed medications, attending follow-up appointments, and making lifestyle changes such as quitting smoking and eating a healthy diet to reduce the risk of future complications. It is important to communicate any concerns or symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for carotid endarterectomy are those who have had a recent stroke or TIA due to significant narrowing (70% to 99%) of the carotid arteries. These patients are at a higher risk of recurrent stroke, and surgery can help reduce this risk. Patients with moderate stenosis (50% to 69%) may also benefit from surgery, although the benefits are less clear. Patients with mild stenosis (less than 50%) may not benefit from surgery and may even be at higher risk of complications.

Overall, the decision to recommend carotid endarterectomy is based on the individual patient’s risk factors, medical history, and the severity of the stenosis. It is important for patients to discuss the potential benefits and risks of surgery with their healthcare provider to make an informed decision about their treatment options.

Timeline

Before carotid endarterectomy:

  1. Patient experiences symptoms such as stroke or transient ischaemic attack (TIA) due to narrowed carotid arteries.
  2. Patient undergoes diagnostic tests such as ultrasound, MRI, or CT scans to confirm the presence and severity of carotid artery stenosis.
  3. Patient may be prescribed medications to manage symptoms and reduce the risk of further strokes.
  4. Patient consults with a vascular surgeon to discuss the option of carotid endarterectomy surgery.

After carotid endarterectomy:

  1. Patient undergoes the surgical procedure to remove the plaque buildup in the carotid artery.
  2. Patient is closely monitored in the hospital for any complications such as bleeding, infection, or stroke.
  3. Patient may need to stay in the hospital for a few days to recover from the surgery.
  4. Patient may experience some temporary side effects such as sore throat, difficulty swallowing, or numbness in the face.
  5. Patient will have follow-up appointments with their healthcare provider to monitor their recovery and assess the effectiveness of the surgery in reducing the risk of future strokes.

What to Ask Your Doctor

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

  1. What are the potential benefits of carotid endarterectomy for my specific condition?
  2. What are the risks and potential complications associated with carotid endarterectomy?
  3. How will the procedure be performed and what is the recovery process like?
  4. Are there any alternative treatment options available for my condition?
  5. How long will it take for me to fully recover after the surgery?
  6. What are the long-term outcomes and success rates of carotid endarterectomy?
  7. Are there any lifestyle changes or medications I need to take after the surgery?
  8. How often will I need to follow up with you after the procedure?
  9. What are the signs and symptoms of potential complications that I should watch out for after the surgery?
  10. Can you provide me with information on the experience and success rates of your medical team with performing carotid endarterectomy procedures?

Reference

Authors: Rerkasem A, Orrapin S, Howard DP, Rerkasem K. Journal: Cochrane Database Syst Rev. 2020 Sep 12;9(9):CD001081. doi: 10.1002/14651858.CD001081.pub4. PMID: 32918282