Clinical Review: Best Medical Therapy Superior to Carotid Endarterectomy in Secondary Stroke Prevention in Symptomatic Extracranial Internal Carotid Artery Stenosis of 50-69%

Blaine C

doi:10.31031/aics.2020.02.000536

Abstract

Transient ischemic attacks (TIA) are known as a herald to an impending stroke or another TIA. Past medical assessment of the risk of stroke following a transient ischemic attack (TIA) commonly quoted a 1-2% risk of stroke at seven days following a TIA and 2-4% risk of stroke at one-month following a TIA

Highlights

Transient ischemic attacks (TIA) are known as a herald to an impending stroke or another transient ischemic attack (TIA)
Extracranial internal carotid artery stenosis poses a high risk of recurrent stroke or transient ischemic attack (TIA) after a TIA or minor stroke
The North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET) first published the result of a study in 1991 to compare medical and surgical therapies in treating the recurrence of cerebrovascular events based on a patient’s degree of carotid stenosis. These early data were based on high grade stenosis as that portion of the trial was concluded early as surgical intervention was clearly superior [4]

Summary

Introduction

Transient ischemic attacks (TIA) are known as a herald to an impending stroke or another TIA. Identifying patients most at risk for stroke following TIA is crucial to initiate the most beneficial intervention This can be done by identifying key risk factors highly associated with stroke rate such as age greater than 60 years old, diabetes mellitus, symptom duration over 10 minutes, weakness, speech impairment [3]. Another major risk to the recurrence of a cerebrovascular event after a TIA or minor stroke is internal carotid stenosis. Previous studies have shown that surgical intervention outweighs the benefits of medical intervention in prevent the recurrent of ipsilateral cerebral ischemic events with patients who have high grade stenosis (70-99% occlusion) of the extracranial internal carotid artery [4]. The best treatment for patients with stenosis of 50-69% of the extracranial internal carotid artery is still controversial

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