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Can Surgery Prevent Stroke and Death?
Yes, surgery can reduce the risk of having a stroke and of the fatal complications of stroke.  However, before all Seabrookers rush out and schedule elective preventive maintenance of this sort, there are a number of important things one needs to know about this very common operation.  If ever there were an instance where consultation with your doctor takes precedence over what you read, this is it.  Surgery is not for everyone, and it is not even for everyone who has medical evidence of severe carotid artery disease. 
  

  

Who is a Canidate for Surgery? 
This surgery is beneficial for symptomatic patients with recent nondisabling carotid artery ischemic events and patients who have evidence of very significant (70% to 99%) carotid artery occlusive blockages on the side of the proposed operation.  The operation should not be performed on patients with mild (0% to 29%) blockage even if they have symptoms.  The symptoms that are amenable to this therapy are transient ischemic syndromes, non-disabling stroke, transient one-sided blindness, or retinal infarction. The symptoms of transient ischemic syndromes include sudden and short-lived weakness or numbness of the face, arm or leg on one side, dimness of vision, trouble speaking, headache, dizziness or unsteadiness.

Decision Making: You and Your Doctor  
The table lists the major factors that need to be considered when one is faced with the decision of whether or not to undergo this type of surgery (see table).  The presence of symptoms is not an absolute indication for the surgery.  This operation can and should be performed in selected patients who have evidence of severe carotid artery occlusion with or without symptoms.  Most patients have symptoms since that is usually what leads to the diagnostic studies which show the arterial stenosis.   There used to be a medical community belief that it was appropriate to wait 30 days between symptoms and surgery, but it has been shown that the sooner the surgery is performed in a good candidate, the better the outcome and greater the reduction of a stroke and possible death.  One often ignored, but crucial factor in the decision to have an operation, is to be certain of the results of the surgeon.  This information should be available and the question to the surgeon or your referring doctor is what is the stroke and death rate after this operation in the last 50 to 100 patients over the past year or two.  The answer should be less than 6% stroke and death rate.  Patients should not be uncomfortable in asking this question: it is important to know that the surgeon has a nationally acceptable complication rate.  Whether or not surgery is performed it is absolutely important to stay on the medical regimen that has been prescribed for you. 

Determinants of Cartotid Endarterctomy Surgery to Prevent Stroke
1. The degree of carotid artery disease (> 20% carotid artery stenosis)
2. The symptoms of the patient
3. The time of last symptoms
4. The results of the surgeon
5. Continued medical therapy 

Other Online Resources:
American Heart Association
American Stroke Association
National Institute of Neurological Disorders and Stroke

Medline Interactive Patient Tutorials:
Surgery and Treatment Procedures-Carotid Endarterectomy

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