The result can be ischemic stroke or transient ischemic attack. These occur because of hemodynamic compromise, embolization, or thrombosis (Greelish, Mohler, Fairman, 2009). The review by Greelish, (2009), includes major trails which evaluate the efficiency as well as clinical variables and risk. There are two major trials discussed in this paper, those are the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial. Each of these demonstrate the efficacy of the carotid endarterectomy in patients who have symptoms such as transcient ischemic attack (Greenlish, et.al, 2009).
The NASCET cohort is another study done that suggests the benefits of CEA in symptomatic patients may be overestimated, since a number of strokes that occur in the territory of stenotic arteries are not preventable by CEA. 1800 patients were included in this study which was done to assure that we knew what the true risk factors of this group of patients with stroke might be. This study showed that that stroke occurred most often in people that had 60% stenosis. This is well supported in all of the studies that were reviewed. Patients with 60% occlusion whether symptomatic or asymptomatic are at great risk.
Risk factors lead to damage in the carotid arteries and th...
Secondary prevention of stroke: risk factor reduction by Furie, Wilterdink and Kistler, (2009) review risk factor management of patients with atherosclerotic cerebrovascular disease, with a focus on secondary prevention in patients who have had ischemic attack or ischemic stroke. Those risk factors that are discussed in great depth in this paper are hypertension, smoking, diabetes, metabolic syndrome, and dyslipidemia. They show statistical data on those patients that control these risk factors and those that don't as well as how the CEA fits into this care (Furie, et. al., 2009). CEA alone will not forever cure a patient with large number of risk factors. The patient has to be willing to participate in this care, also.
Cardiovascular disease, MI or ischemic stroke is still the leading cause of death in patients with metabolic syndrome and diabetes. Haffey, (2009), suggests success in saving lives here is based on effectively treating the whole patient. The author describes throughout his paper, different clinical approaches to achieving this goal. He reminds that treating those things that are risk factors for the disease should be dealt with aggressively. Those include hypertension, smoking, activity levels, dietary habits, obesity, carotid artery stenosis, and atrial fibrillation (Haggey, 2009). Again, as in the previous literature, Dr. Haggey suggests that there be a great deal of follow up assuring that these patients are doing what has to be done to decrease their risk factors.
There have been three very high quality clinical trials on patients who need carotid endarterectomy but are asymptomatic. Those trials are the Veterans Affairs Cooperative Study Group, the Asymptomatic Carotid Atherosclerosis Study, and the Asymptomatic Carotid