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

Ihor I. Kobza 1, Vasyl V. Pelekh 2, * and Yuliya S. Mota 1

1 Department of Surgery No.2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
2 Department of Vascular Surgery, Lviv Regional Clinical Hospital, Lviv, Ukraine.
 
Research Article
World Journal of Biology Pharmacy and Health Sciences, 2024, 17(03), 268–272.
Article DOI: 10.30574/wjbphs.2024.17.3.0141
Publication history: 
Received on 12 February 2024; revised on 19 March 2024; accepted on 21 March 2024
 
Abstract: 
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.
 
Keywords: 
Case report; Carotid endarterectomy; Stroke; Decision-making; Neurological deficits.
 
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