Role of Carotid Endarterectomy in Acute Ischemic Stroke

초록

Major goal of carotid endartrectomy is to reestablish the carotid flow safely and to remove the risk of future stroke in vulnerable stroke patients. Carotid endarterectomy has been improved continuously in its technical aspect since it had been introduced as an effective treatment option in 1950s and. Although highly effective, there are some limitations and issues, which are controversial still. Selection of patients can be an issue in the symptomatic lesion because there are many factors, that should be considered, such as the extent of recent infarction, surgical timing in patients with recent stroke and co existence of intracranial aneurysm or coronary artery occlusive disease. Many surgeons agree to do carotid endarterectomy (CEA) for symptomatic lesion with severe degree of stenosis, but benefits of CEA seem to be very small in nonsymtomatic lesions, even if they have severe degree of stenosis. Urgent carotid endarterectomy generally is not performed in patients with acute large cerebral infarction because the sudden restoration of blood flow may increase the development of brain edema or lead to hemorrhagic transformation. However, in some cases such as patients showing progressing stroke with minor infarction, carotid endarteectomy could be considered first line revascularization tool. And there are several issues also in endartectomy timing of patients with acute ischemic stroke. Another issue is in the management of the near or total occlusion of extracranial internal carotid artery treatment. Their treatment algorithm is not established fully and clear indication of surgical intervention in each step should be established to make proper treatment algorithm. Author will discuss the above issues on the basis of published reports and personal experiences and will present the basic technique of carotid endarterctomy also.