There are many causes for brain strokes. As stated above, one of the causes is the narrowing of the carotid arteries which causes blood clots to travel up to the brain. In patients who suffer from a heart condition, diabetes and/or are at high risk for atherosclerosis (smoking, high blood pressure and hyperlipidemia) there is a 50% chance that they have common carotid artery atherosclerosis. This disease can be detected by undergoing a Doppler examination of the common carotid arteries. Further imaging will include computed tomography of the brain and sometimes also a computed tomography angiogram of the neck and the aortic arch arteries, in order to decide on the course of continued treatment and surgical intervention.
Treatment of carotid artery stenosis by medication alone includes the drugs aspirin and Plavix. Surgical intervention, called carotid endarterectomy, to reduce the risk of brain strokes, has been done for the last 50 years, and in the 90's was proven as significant in the prevention of brain strokes in symptomatic patients with severe stenosis (narrowing).
After a temporary or fixed brain stroke there is a very high risk for a secondary stroke during the weeks following the first stroke, and therefore quick intervention is crucial. There are also cases where carotid endarterectomy is performed on patients with severe stenosis (narrowing) but without the active disease (such as in young patients, bilateral disease etc.).
One of the risks in undergoing carotid endarterectomy is a brain stroke. In asymptomatic patients the risk is less than1%, while in symptomatic patients the risk is between 2-4%. However, the risk for symptomatic patients who do not undergo carotid endarterectomy for a recurring stroke is much greater and can reach 20% and higher.
Other substantial risks include a low percentage of patients who are known to suffer from a heart condition and could have cardiac-related complications during the carotid endarterectomy. There must be a cardiac assessment and approval prior to surgical intervention.
Other common phenomena include blood pressure changes around the surgical area, and local hematoma in the neck.
