SURGICAL MANAGEMENT OF CAROTlD ARTERY STENOSIS

Abstract

Carotid artery stenosis is responsible for 20-30% of cases of stroke recorded in medical literature. Therefore, prophylactic treatment of this stenosis is considered a very important item in the attempt to reduce the incidence ofcerebral stroke. ,

There are many modalities of treatment designed to tackle the problem of carotid artery stenosis, namely: 1. Conservative treatment including antiplatelets and anticoagulants, 2. Surgical intervention (carotid endarterectomy), or more recently, 3. Percutaneous transluminal angioplasty.

Carotid endarterectomy remains the golden standard of treatment for carotid artery stenosis, and is the commonest procedure used in its management. Carotid endarterectomy (CEA) is indicated in symptomatic cases with stenosis of more than 70% or in asymptomatic cases with stenosis of more than 80%. The presence of an ulcerative lesion of grade C is also a solid indication for surgery. CEA can be performed under either local or general anaesthesia. Shunts, for example the Javid type, should be used if the \• patient developed manifestations of cerebral ischaemia under local anaesthesia, or if the carotid stump pressure is less than 60 mmHg, or whenever there are EEG changes of cerebral ischaemia under general anaesthesia.