The patient is worried about the quality of her vessels and the risk of developing a cerebrovascular accident. She heard that it may be an option to operate on her narrowing vessels? What should she do?
Whether or not to intervene in asymptomatic patients has been debated for years. The new ESVS guideline has made an attempt to aim in decision making. Key is to define who might be at high risk of stroke despite best medical treatment.
With the information at hand, she has two features associated with an increased risk of stroke with best medical treatment; a history of a TIA and progression of the left carotid artery stenosis. The life expectancy is ≥ 5 years and the anatomy of the left carotid artery is favorable; the patient is slim, the bifurcation is low and the stenosis is short.
You use the flow diagram below to explain your findings with the patient, and discuss that invasive treatment of the left carotid artery stenosis may be an option to prevent long term stroke.
You explain that the aim of invasive treatment is to prevent long term ipsilateral stroke in patients who are considered at higher risk on best medical treatment. However, the risk of stroke due to the procedure, reported in literature to be around 3%, is one of the major drawbacks. You recently had a quality report in your own institute which revealed a similar perioperative risk for death/stroke
