The curative effect of carotid endarterectomy


Authors: J. Mraček 1;  I. Holečková 1;  J. Mork 1;  P. Ševčík 2
Authors‘ workplace: Univerzita Karlova v Praze, Lékařská fakulta a FN Plzeň, Neurochirurgické oddělení 1;  Univerzita Karlova v Praze, Lékařská fakulta a FN Plzeň, Neurologická klinika 2
Published in: Čas. Lék. čes. 2009; 148: 326-329
Category: Case Report

Overview

The preventive effect of carotid endarterectomy in the reduction of ischemic stroke was reliably confirmed. Carotid endarterectomy may also be a curative method, but it has not been confirmed yet. In our case report we illustrate the curative effect of carotid endarterectomy in a patient after a combined embolic and hemodynamic stroke. The administration of intravenous thrombolysis did not have the expected clinical response. Neuroimaging showed ischemia and homolateral hypoperfusion of the brain hemisphere caused by critical internal carotid artery stenosis. On the 8th day after thrombolysis a carotid endarterectomy was performed with beneficial effect. Normalization of hemodynamic in the altered hemisphere was demonstrated by perfusion examination along with the clinical improvement.

A curative effect of endarterectomy appears more probable in a hemodynamic ischemic stroke. For the improvement of a neuronal function the existence of penumbra is a condition. While a positive influence of hemodynamic by carotid endarterectomy is confirmed, the possibility of an increase in neuronal activity after repair of vasomotor activity is not documented. The curative effect and itʼs connection to the timing of the carotid endarterectomy require testing in the further studies.

Key words:
carotid endarterectomy, curative, hemodynamic stroke, ischemic penumbra, cerebrovascular reserve.


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