Transient ischemic attack surgery: Difference between revisions
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==Overview== | ==Overview== | ||
For people with a greater than 70% stenosis within the carotid artery, removal of atherosclerotic plaque by surgery, specifically a [[carotid endarterectomy]], may be recommended. | For people with a greater than 70% stenosis within the carotid artery, removal of atherosclerotic plaque by surgery, specifically a [[carotid endarterectomy]], may be recommended.<ref name="pmid17000964">{{cite journal| author=Rajajee V, Kidwell C, Starkman S, Ovbiagele B, Alger JR, Villablanca P et al.| title=Early MRI and outcomes of untreated patients with mild or improving ischemic stroke. | journal=Neurology | year= 2006 | volume= 67 | issue= 6 | pages= 980-4 | pmid=17000964 | doi=10.1212/01.wnl.0000237520.88777.71 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17000964 }} </ref><ref name="pmid17673713">{{cite journal| author=Nedeltchev K, Schwegler B, Haefeli T, Brekenfeld C, Gralla J, Fischer U et al.| title=Outcome of stroke with mild or rapidly improving symptoms. | journal=Stroke | year= 2007 | volume= 38 | issue= 9 | pages= 2531-5 | pmid=17673713 | doi=10.1161/STROKEAHA.107.482554 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17673713 }} </ref> | ||
==Surgery== | ==Surgery== | ||
Carotid endartectomy may be performed within 2 weeks of cerebral or retinal TIA in those with TIA attributed to a high-grade internal carotid artery stenosis: | Surgical management of patients with TIA may include the following: | ||
===Mechanical thrombectomy=== | |||
There is limited evidence to support the use of mechanical thrombectomy in patients with minor or transient ischemic stroke. Large vessel occlusion is a poor predictor of neurological disability in patients having transient ischemic attack. According to AHA/ASA guidelines, it is postulated that patients with NIHSS score <6 or having evidence of large vessel occlusion may benefit from early endovascular therapy.<ref name="pmid17000964">{{cite journal| author=Rajajee V, Kidwell C, Starkman S, Ovbiagele B, Alger JR, Villablanca P et al.| title=Early MRI and outcomes of untreated patients with mild or improving ischemic stroke. | journal=Neurology | year= 2006 | volume= 67 | issue= 6 | pages= 980-4 | pmid=17000964 | doi=10.1212/01.wnl.0000237520.88777.71 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17000964 }} </ref><ref name="pmid17673713">{{cite journal| author=Nedeltchev K, Schwegler B, Haefeli T, Brekenfeld C, Gralla J, Fischer U et al.| title=Outcome of stroke with mild or rapidly improving symptoms. | journal=Stroke | year= 2007 | volume= 38 | issue= 9 | pages= 2531-5 | pmid=17673713 | doi=10.1161/STROKEAHA.107.482554 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17673713 }} </ref><ref name="pmid26123479">{{cite journal| author=Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC et al.| title=2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. | journal=Stroke | year= 2015 | volume= 46 | issue= 10 | pages= 3020-35 | pmid=26123479 | doi=10.1161/STR.0000000000000074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26123479 }} </ref><ref name="pmid27375548">{{cite journal| author=Yakhkind A, McTaggart RA, Jayaraman MV, Siket MS, Silver B, Yaghi S| title=Minor Stroke and Transient Ischemic Attack: Research and Practice. | journal=Front Neurol | year= 2016 | volume= 7 | issue= | pages= 86 | pmid=27375548 | doi=10.3389/fneur.2016.00086 | pmc=4901037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27375548 }} </ref> | |||
===Carotid Endartectomy=== | |||
Carotid endartectomy may be performed within 2 weeks of cerebral or retinal TIA in those with TIA attributed to a high-grade internal carotid artery stenosis:<ref name="pmid16912978">{{cite journal| author=Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA et al.| title=National Stroke Association guidelines for the management of transient ischemic attacks. | journal=Ann Neurol | year= 2006 | volume= 60 | issue= 3 | pages= 301-13 | pmid=16912978 | doi=10.1002/ana.20942 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16912978 }} </ref><ref name="pmid24788967">{{cite journal| author=Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD et al.| title=Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. | journal=Stroke | year= 2014 | volume= 45 | issue= 7 | pages= 2160-236 | pmid=24788967 | doi=10.1161/STR.0000000000000024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24788967 }} </ref><ref name="pmid27375548">{{cite journal| author=Yakhkind A, McTaggart RA, Jayaraman MV, Siket MS, Silver B, Yaghi S| title=Minor Stroke and Transient Ischemic Attack: Research and Practice. | journal=Front Neurol | year= 2016 | volume= 7 | issue= | pages= 86 | pmid=27375548 | doi=10.3389/fneur.2016.00086 | pmc=4901037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27375548 }} </ref> | |||
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===Extracranial-Intracranial Bypass=== | |||
Extracranial-intracranial bypass is not recommended in patients with TIA.<ref name="pmid16912978">{{cite journal| author=Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA et al.| title=National Stroke Association guidelines for the management of transient ischemic attacks. | journal=Ann Neurol | year= 2006 | volume= 60 | issue= 3 | pages= 301-13 | pmid=16912978 | doi=10.1002/ana.20942 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16912978 }} </ref> | |||
†Recommended only in certain patients and at centres with perioperative complication rate of <6% | †Recommended only in certain patients and at centres with perioperative complication rate of <6% | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
Latest revision as of 00:29, 30 July 2020
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Transient ischemic attack Microchapters |
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Differentiating Transient Ischemic Attack from other Diseases |
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Diagnosis |
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Treatment |
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Transient ischemic attack surgery On the Web |
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American Roentgen Ray Society Images of Transient ischemic attack surgery |
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Risk calculators and risk factors for Transient ischemic attack surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
For people with a greater than 70% stenosis within the carotid artery, removal of atherosclerotic plaque by surgery, specifically a carotid endarterectomy, may be recommended.[1][2]
Surgery
Surgical management of patients with TIA may include the following:
Mechanical thrombectomy
There is limited evidence to support the use of mechanical thrombectomy in patients with minor or transient ischemic stroke. Large vessel occlusion is a poor predictor of neurological disability in patients having transient ischemic attack. According to AHA/ASA guidelines, it is postulated that patients with NIHSS score <6 or having evidence of large vessel occlusion may benefit from early endovascular therapy.[1][2][3][4]
Carotid Endartectomy
Carotid endartectomy may be performed within 2 weeks of cerebral or retinal TIA in those with TIA attributed to a high-grade internal carotid artery stenosis:[5][6][4]
| Degree of carotid artery stenosis | Carotid endartectomy |
|---|---|
| 70-99% internal carotid artery stenosis | Recommended |
| 50-69% stenosis | Recommended only in specific situation† |
| <50% stenosis | Not recommended |
Extracranial-Intracranial Bypass
Extracranial-intracranial bypass is not recommended in patients with TIA.[5]
†Recommended only in certain patients and at centres with perioperative complication rate of <6%
References
- ↑ 1.0 1.1 Rajajee V, Kidwell C, Starkman S, Ovbiagele B, Alger JR, Villablanca P; et al. (2006). "Early MRI and outcomes of untreated patients with mild or improving ischemic stroke". Neurology. 67 (6): 980–4. doi:10.1212/01.wnl.0000237520.88777.71. PMID 17000964.
- ↑ 2.0 2.1 Nedeltchev K, Schwegler B, Haefeli T, Brekenfeld C, Gralla J, Fischer U; et al. (2007). "Outcome of stroke with mild or rapidly improving symptoms". Stroke. 38 (9): 2531–5. doi:10.1161/STROKEAHA.107.482554. PMID 17673713.
- ↑ Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC; et al. (2015). "2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. 46 (10): 3020–35. doi:10.1161/STR.0000000000000074. PMID 26123479.
- ↑ 4.0 4.1 Yakhkind A, McTaggart RA, Jayaraman MV, Siket MS, Silver B, Yaghi S (2016). "Minor Stroke and Transient Ischemic Attack: Research and Practice". Front Neurol. 7: 86. doi:10.3389/fneur.2016.00086. PMC 4901037. PMID 27375548.
- ↑ 5.0 5.1 Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA; et al. (2006). "National Stroke Association guidelines for the management of transient ischemic attacks". Ann Neurol. 60 (3): 301–13. doi:10.1002/ana.20942. PMID 16912978.
- ↑ Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD; et al. (2014). "Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 45 (7): 2160–236. doi:10.1161/STR.0000000000000024. PMID 24788967.