Current Indications of Surgery and Endovascular Treatment in Ischemic Stroke

Yim, Man Bin; Lee, Chang Young; Kim, Il Man; Son, Eun Ik; Kim, Dong Won

Abstract

OBJECTIVE
To know the indications and logics of surgical and endovascualar treatment for patients with carotid stenosis.
METHODS
The surgical indications and logics of symptomatic and asymptomatic carotid stenosis, and indication of angioplasty and stenting for carotid stenosis are discussed with the review of literatures.
RESULTS
Carotid endarterectomy is indicated in patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter and patients with symptomatic (recent transient ischemic attacks or nondisabling strokes) high-grade carotid stenosis (70 to 99%) with or without contralateral carotid stenosis or occlusion. The angioplasty and stenting for carotid stenosis may be indicated in patients who have the significant medical comorbidity, recurrent high-grade stenosis after endarterectomy, contralateral carotid occlusion, radiation induced stenosis, surgically difficult to access high-cervical stenosis and tandem lesion.
CONCLUSION
Neurologists who have the primary management role for the cerebral ischemic patient in our country should be familiar with the surgical indications of carotid stenosis. They should try to find the patients who need the carotid endarterectomy and recommend them to surgeon to have the surgery. The cooperation among neurologist, neuroradiologist, vascular surgeon and neurosurgeon will improve the management results of patients with cerebral ischemic disease.