Our Summary

This research study is about two procedures used to treat a condition called carotid artery stenosis, which is a narrowing of the arteries that supply blood to the brain and can cause a stroke. The two procedures are carotid endarterectomy (CEA), which involves a surgical incision into the carotid artery to remove the blockage, and carotid artery stenting (CAS), which involves inserting a small, wire-mesh tube called a stent to keep the artery open.

This study looked at patients who underwent either procedure between 2012 and 2020 to see if there were any differences in the outcomes. They found that there wasn’t a significant difference between the two procedures in terms of complications like heart attack and stroke, or patient deaths, in the 30 days following the surgery. This suggests that both surgeries are similarly effective in preventing strokes and have similar risk levels for complications.

FAQs

  1. What is carotid artery stenosis and how is it treated?
  2. What are the differences between carotid endarterectomy and carotid artery stenting?
  3. Were there any significant differences in outcomes between the two procedures according to the study conducted from 2012 to 2020?

Doctor’s Tip

One helpful tip a doctor might tell a patient about carotid endarterectomy is to follow all pre-operative instructions carefully. This may include stopping certain medications, fasting before the surgery, and avoiding certain foods or drinks. Following these instructions can help reduce the risk of complications during and after the procedure. Additionally, it is important to follow all post-operative care instructions provided by your healthcare team to ensure a successful recovery.

Suitable For

Patients who are typically recommended for carotid endarterectomy are those who have symptomatic carotid artery stenosis, meaning they have experienced symptoms such as transient ischemic attacks (TIAs) or strokes related to the narrowed artery. These patients are at a higher risk of having a future stroke if the blockage is not treated.

Additionally, patients with asymptomatic carotid artery stenosis may also be recommended for carotid endarterectomy if they have a high degree of stenosis (typically greater than 70%) and are otherwise healthy and able to tolerate the surgery. The decision to undergo carotid endarterectomy is usually based on the patient’s overall health, the severity of the stenosis, and their risk factors for stroke.

It is important for patients to discuss their individual case with their healthcare provider to determine if carotid endarterectomy is the best treatment option for them.

Timeline

Before the procedure:

  • Patient undergoes diagnostic tests such as carotid ultrasound, magnetic resonance angiography (MRA), or computed tomography angiography (CTA) to determine the extent of carotid artery stenosis.
  • Patient may be prescribed medications to help manage their symptoms and reduce the risk of complications.
  • Patient meets with their healthcare team to discuss the procedure, risks, benefits, and recovery process.

During the procedure:

  • Patient is placed under anesthesia.
  • Surgeon makes an incision in the neck to access the carotid artery.
  • Surgeon removes the plaque buildup from the artery and repairs any damage.
  • Patient is monitored closely during the procedure for any complications.

After the procedure:

  • Patient is monitored in the hospital for a period of time to ensure there are no immediate complications.
  • Patient may experience some pain, swelling, or bruising at the incision site.
  • Patient may need to take medications to prevent blood clots and manage pain.
  • Patient is instructed on how to care for the incision site and when to follow up with their healthcare team.
  • Patient may need to participate in rehabilitation or physical therapy to regain strength and mobility.

Overall, carotid endarterectomy is a relatively safe and effective procedure for treating carotid artery stenosis and reducing the risk of stroke. Patients may experience some discomfort and require a period of recovery, but the benefits of the surgery in preventing future strokes outweigh the potential risks.

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 other treatment options for carotid artery stenosis?
  2. How many carotid endarterectomy procedures have you performed, and what is your success rate?
  3. What is the recovery process like after carotid endarterectomy, and how long will it take to fully recover?
  4. What are the potential complications or side effects of carotid endarterectomy, and how likely are they to occur?
  5. How long will the effects of carotid endarterectomy last, and will I need any additional treatments or follow-up care?
  6. Are there any lifestyle changes or medications I should consider after undergoing carotid endarterectomy to prevent future blockages or strokes?
  7. How will carotid endarterectomy improve my symptoms or reduce my risk of having a stroke in the future?
  8. Are there any specific criteria or tests that need to be met before I can undergo carotid endarterectomy?
  9. How soon after the procedure can I return to my normal activities, such as driving or exercising?
  10. Are there any alternative treatments or procedures that may be more suitable for my specific condition or health concerns?

Reference

Authors: Cho JS, Song S, Huh U, Lee CW, Lee JI, Ko JK, Lee TH, Hwangbo L, Sung SM, Cho HJ, Kim GM. Journal: Ann Palliat Med. 2022 Nov;11(11):3409-3416. doi: 10.21037/apm-22-797. Epub 2022 Nov 7. PMID: 36366894