Endovascular Treatments for Brain Aack Introduction - Microsurgery: Advances, Simulations, and Applications - page 56

2.2.1 Treatment

The treatment for those patients includes prescription of anti-
platelets agents; additionally it is needed to prescribe synthetic
internal medicine treatments such as high blood pressure, anti-
hyperlipidemia and diabetes control medicaments. However, for
blood vessels with narrowing ratio above 70%, surgery complications
occur in 6% of cases. The addition of carotid artery endarterectomy
(CEA) to the best internal medicine treatments satisfactory improves
prognosis [27]. Even if carotid artery stenosis lacks symptoms,
surgical complications occur in less than 3% of the cases. For 60% of
cases, the prognosis of treatments relying on CEA is better than for
internal medicine treatments [28].
Similar to CEA, another treatment for carotid artery stenosis is
the carotid artery stenting (CAS). The treatment with CEA has to
adapt to dificult cases (acute lesion) and treatment failure factors
(age, cardiac infarcts precedents); for those cases, it was veriied that
the use of protection devices improves the treatment effectiveness
and safety [29-30]. Within the CAS study, CAS superiority over CEA
within the group with low CEA treatment failure factor has not been
veriied yet [30-32].

2.2.2 Carotid Artery Endarterectomy

The most common treatment for carotid artery stenosis is surgical
treatment. Under general anesthesia, the skin of the patient neck is
cut. After peeling off the sternocleidomastoid anterior border and
internal jugular vein, the common carotid artery, internal jugular
vein and external carotid artery are exposed. After interrupting the
blood low in those arteries, an incision is made at the region where
the stenosis is present, opening from the common carotid artery to
the internal carotid artery. Then the peeling of the plaque thickening
in the internal membrane starts. In some cases, the ablation of the
diseased artery is needed. To reduce the time for which the blood
low is interrupted during the surgery, an internal shunt is used
(Fig 2.10).