Carotid Endarterectomy for TIA and Stroke

Carefully weigh the benefits and risks of surgery, and compare them with the benefits and risks of medicine therapy. The success of medicine therapy will depend on how much narrowing (stenosis) is present in the arteries and the choice of medicine. Risks of surgery depend on your age, your overall health, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.

Tests such as carotid ultrasound, carotid arteriography, CT angiography, or magnetic resonance angiography (MRA) are needed before surgery to evaluate the amount of plaque buildup in the carotid arteries and the flow of blood through the narrowed area. (For more information, see the Exams and Tests section of the topic Stroke.) The blood vessels beyond the hardened area are also evaluated. If those vessels are severely damaged, surgery may not be helpful.

Carotid endarterectomy can be done several months after a stroke or TIA. But people benefit most from the surgery if it is done within 2 weeks of the stroke or TIA. Delaying surgery longer than 2 weeks increases the risk for stroke, because people are more likely to have a stroke in the first few days and weeks after a first stroke or a TIA.

The likelihood of complications from carotid endarterectomy varies, depending on the skill and experience of the surgeon. The American Heart Association Stroke Council recommends that surgery be done by a surgeon who has complications in less than 6% of the endarterectomy surgeries that he or she performs and that the hospital rate of complications be just as low.^{Reference 2}

• Before surgery, any medical condition that increases the risk for stroke, such as Reference high blood pressure Opens New Window or heart disease, needs to be controlled.
• The benefits of surgery may be temporary if disease or causes are not also treated. Using long-term aspirin treatment, getting regular exercise, lowering cholesterol levels, eating a low-fat diet, and quitting smoking are important aspects of postsurgery treatment.

Complete the surgery information form (PDF) (What is a Reference PDF Opens New Window document?) to help you prepare for this surgery.

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