Makindo Medical Notes"One small step for man, one large step for Makindo" |
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CEA is recommended for 50โ99% stenosis (NASCET) or 70โ99% (ECST) in patients with TIA or non-disabling stroke. Ideally within 48 hrs, no later than 2 weeks.
Complication | Details |
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Ischaemic Stroke | Due to thrombus, dissection, or emboli. Requires urgent CT to exclude ICH and CTA for vessel status. Manage with antiplatelets/anticoagulation, sometimes re-exploration or stenting. |
Restenosis | ~5% at 2 yrs. Due to early neointimal hyperplasia or late atherosclerosis. Managed with medical therapy; some may need stenting or repeat surgery. |
Hyperperfusion Syndrome | Loss of autoregulation โ oedema, seizures, headache, ICH. Occurs Day 3โ10. Manage with strict BP control and neuroimaging (CT/MRI). |
Local Nerve Injury | Hypoglossal, vagus, glossopharyngeal nerves at risk (LMN palsy). Usually traction-related. Recovery over months; sometimes permanent. |
Post-op ICH | Usually <72 hrs, worsened by anticoag/antiplatelets. Treat as acute ICH. |
Wound issues | Dehiscence, infection โ rare. |
Severity of stenosis | Relative Risk Reduction | Absolute Risk Reduction | NNT (2 yrs) |
---|---|---|---|
Occluded | Not for surgery | โ | โ |
Symptomatic 70โ99% | 65% | 13% | 8 |
Symptomatic 50โ69% | 30% | 7% | 14 |
Symptomatic <50% | No benefit | โ | โ |
๐ก Surgery offers greatest benefit within days of the event. Benefit is limited in women, those with ocular events, lacunar strokes, contralateral occlusion, or distal vessel collapse. Minimal/no benefit after 3โ6 months delay or in asymptomatic stenosis.