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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Transient ischemic attack surgery

Introduction

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.[1][2]

Surgery

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

References

  1. ↑ 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. ↑ 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.
  3. ↑ 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. ↑ 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. ↑ 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.
  6. ↑ 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.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]