Transient Ischemic Attack (TIA): Surgery

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Surgery

If you have significant blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgical procedure, a surgeon removes plaque buildup in the carotid arteries to reduce the risk of transient ischemic attack (TIA) or stroke. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke. Your need to have carotid endarterectomy depends on whether you have had a TIA and how much your carotid arteries have narrowed.

Should I have carotid endarterectomy surgery for TIA?

You are most likely to benefit from surgery if you have had a TIA in the past 6 months that was caused by a 70% or greater narrowing in one of your carotid arteries. Carotid endarterectomy is also appropriate if your carotid arteries are moderately or severely blocked (50% to 70% or more) and you have had one or more TIAs.⁹ Talk to your doctor about whether a carotid endarterectomy is right for you.

A relatively new procedure called carotid artery stenting is another option for some people who are at high risk of stroke. This procedure is much like coronary angioplasty, which is commonly used to open blocked arteries in the heart. During this procedure, a vascular surgeon inserts a metal tube called a stent inside your carotid artery to increase blood flow in areas blocked by plaque. The surgeon may use a stent that is coated with medicine to help prevent future blockage. Carotid artery stenting is not as common as endarterectomy.

Each person must carefully weigh the benefits and risks of surgery and compare them with the benefits and risks of using medicine to reduce the risk of TIA or stroke. The success of either treatment will depend on the amount of blockage you have and which medicine you use. Risks of surgery depend on your age, your health status, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.

Surgery Choices

Carotid endarterectomy

What To Think About

Carotid endarterectomies are most successful when they are done by a surgeon who is well trained in the procedure and in a hospital that is well equipped to take care of any complications that may occur during or after the procedure.

If you are considering carotid endarterectomy, ask the hospital or state medical board about the number of times complications have occurred in people that your doctor has treated with this surgery and the complication rate at the hospital where the surgery is to be done. The American Heart Association Stroke Council recommends that surgery be performed by a surgeon who has complications in less than 3% of those treated and that the hospital rate of complications be just as low.⁹

While carotid endarterectomy is often not done until several months after a TIA, a large study showed that people benefit most from the surgery if it is done within 2 weeks of a TIA. Delaying surgery longer than 2 weeks increases the risk for stroke because people are more likely to have a stroke in the first few days and weeks after a TIA. These results also point out why it is so important to see a doctor immediately if you have any signs of TIA.¹⁰

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Last updated:	May 23, 2007
Author:	Robin Parks, MS
Reviewed By:	Anne C. Poinier, MD - Internal Medicine, Karin M. Lindholm, DO - Neurology
Editors:	Kathleen M. Ariss, MS, Pat Truman