Carotid endarterectomy in a patient with recurrent transient ischemic attacks and burdened neurological history: A decision-making dilemma: Case report

Introduction: in symptomatic patients with carotid artery disease (CAD), carotid endarterectomy (CEA) reduces the risk of major stroke and is highly beneficial in patients with 70% to 99% stenosis. However, patients with burdened neurological history, risk factors, and relative contraindications for surgery require thoughtful decision-making.
Case presentation: 51-year-old male patient with a previous ischemic stroke (mRS 3) with an area of infarction that exceeds one-third of the right middle cerebral artery, who had ipsilateral carotid artery critical stenosis and contralateral near-occlusion and suffered from recurrent ipsilateral transient ischemic attacks (TIA) despite being on medical treatment. The patient underwent CEA and was discharged on postoperative day 5 with partial improvement of neurological deficit. Follow-up on postoperative day 30 was unremarkable, after which neurological improvement occurred, and the patient was successfully discharged.
Conclusion: It is possible to perform CEA in symptomatic patients with significant neurological deficits and brain lesions if conservative treatment is ineffective and there are factors indicating the necessity for surgical intervention.