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When the carotid artery becomes partially blocked (stenosis) or completely obstructed (occlusion) by atherosclerotic disease (plaque), one of the four main pathways for blood flow to the brain is compromised. If small pieces of this plaque break off and travel to the brain (embolize), this can produce a wide spectrum of deficits, from transient symptoms with complete neurologic recovery between attacks to the death of areas of brain tissue (infarction) resulting in disabling strokes and sometimes even death. Untreated, the principal risk of carotid artery disease is major stroke on the same side of the brain as the
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obstruction (ipsilateral stroke) due to lack of adequate blood flow (ischemia). The degree of stroke risk depends upon many factors - the age and medical condition of the patient, the existence and extent of neurologic deficits, whether or not there is occlusion of both carotid arteries or just one, the condition of collateral blood flow in the brain, the extent of the stenosis or occlusion, and whether the plaque is ulcerated. Carotid endarterectomy surgery may be the treatment of choice. It is a common procedure where the carotid artery is opened up surgically in order to clean out the obstructing plaque.
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There is general consensus in the medical literature about who is a proper candidate for carotid endarterectomy surgery. The most significant and dreaded complication of carotid endarterectomy surgery is cerebral infarction (stroke) which, ironically, is the same general risk that the surgery itself is intended to reduce. Post operative stroke rates of 1% - 3% are reported in numerous studies. The rationale for surgery is that the stroke risk is significantly higher for a given patient without surgery than the stroke risk of the surgery. The experience and results of the surgeon is also widely recognized as a critical factor in outcome.
The important thing to know about post-operative strokes is that they may be treated with a high degree of success by early surgical re-exploration of the carotid endarterectomy site. The majority of strokes in the early post operative period (up to 24 hours) are the result
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