Cardiac Endarterectomy Confers Maximum Benefit In The First Two Weeks After Onset Of A Transient Ischemic Attack

Main Category: Stroke
Also Included In: Cardiovascular / Cardiology;  Neurology / Neuroscience
Article Date: 24 Nov 2008 - 7:00 PDT

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Dr. Naylor from Leicester (UK) Royal Infirmary addressed an important question concerning timing of treatment of carotid disease after a patient has had a transient ischemic attack (TIA).

He reviewed many trials and was able to conclude that the risk of stroke after suffering a TIA is maximal in the first 7 days and carotid endarterectomy confers maximum benefit in the first two weeks after TIA onset.

Expedited surgery or angioplasty is probably associated with a small increase in the procedural risk but this does not negate any long term benefit.

Even with a procedural risk as high as 10%, considerable long term benefit is maintained.

Future guideline makers must include an allowance for a small increase in the accepted procedural risk where surgery and angioplasty is undertaken within 2 weeks of symptom onset.

A Systematic Review and meta-analysis of several of the larger randomized trials will hopefully determine whether CEA or CAS is preferred when treating patients within 2 weeks of onset of symptoms. Ultimately, posed Dr. Naylor, delay may reduce the procedural risk, but at what price to the patient?

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Source
Pauline T. Mayer
www.ptmhcm.com