Transient ischemic attack surgery
|
Transient ischemic attack Microchapters |
|
Differentiating Transient Ischemic Attack from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Transient ischemic attack surgery On the Web |
|
American Roentgen Ray Society Images of Transient ischemic attack surgery |
|
Risk calculators and risk factors for Transient ischemic attack surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
For people with a greater than 70% stenosis within the carotid artery, removal of atherosclerotic plaque by surgery, specifically a carotid endarterectomy, may be recommended.[1][2]
Surgery
Surgical management of patients with TIA may include the following:
Mechanical thrombectomy
There is limited evidence to support the use of mechanical thrombectomy in patients with minor or transient ischemic stroke. Large vessel occlusion is a poor predictor of neurological disability in patients having transient ischemic attack. According to AHA/ASA guidelines, it is postulated that patients with NIHSS score <6 or having evidence of large vessel occlusion may benefit from early endovascular therapy.[1][2][3][4]
Carotid Endartectomy
Carotid endartectomy may be performed within 2 weeks of cerebral or retinal TIA in those with TIA attributed to a high-grade internal carotid artery stenosis:[5][6][4]
| Degree of carotid artery stenosis | Carotid endartectomy |
|---|---|
| 70-99% internal carotid artery stenosis | Recommended |
| 50-69% stenosis | Recommended only in specific situation† |
| <50% stenosis | Not recommended |
Extracranial-Intracranial Bypass
Extracranial-intracranial bypass is not recommended in patients with TIA.[5]
†Recommended only in certain patients and at centres with perioperative complication rate of <6%
References
- ↑ 1.0 1.1 Rajajee V, Kidwell C, Starkman S, Ovbiagele B, Alger JR, Villablanca P; et al. (2006). "Early MRI and outcomes of untreated patients with mild or improving ischemic stroke". Neurology. 67 (6): 980–4. doi:10.1212/01.wnl.0000237520.88777.71. PMID 17000964.
- ↑ 2.0 2.1 Nedeltchev K, Schwegler B, Haefeli T, Brekenfeld C, Gralla J, Fischer U; et al. (2007). "Outcome of stroke with mild or rapidly improving symptoms". Stroke. 38 (9): 2531–5. doi:10.1161/STROKEAHA.107.482554. PMID 17673713.
- ↑ Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC; et al. (2015). "2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. 46 (10): 3020–35. doi:10.1161/STR.0000000000000074. PMID 26123479.
- ↑ 4.0 4.1 Yakhkind A, McTaggart RA, Jayaraman MV, Siket MS, Silver B, Yaghi S (2016). "Minor Stroke and Transient Ischemic Attack: Research and Practice". Front Neurol. 7: 86. doi:10.3389/fneur.2016.00086. PMC 4901037. PMID 27375548.
- ↑ 5.0 5.1 Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA; et al. (2006). "National Stroke Association guidelines for the management of transient ischemic attacks". Ann Neurol. 60 (3): 301–13. doi:10.1002/ana.20942. PMID 16912978.
- ↑ Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD; et al. (2014). "Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 45 (7): 2160–236. doi:10.1161/STR.0000000000000024. PMID 24788967.