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CNI Neurovascular Surgery Service
Patient Care
Treatments
Carotid Endarterectomy
This procedure involves surgically exposing the carotid artery, temporarily clamping it, removing the atherosclerotic material, and stitching the artery closed (Figure 1). Following removal of the clamps, flow is restored. Sometimes, narrowing of the carotid is discovered in the absence of symptoms. In certain circumstances, it is helpful to perform endarterectomy for non-symptomatic narrowing.
Cerebral Revascularization
The usual method for revascularization is superficial temporal to middle cerebral artery bypass (STA-MCA). On occasion, a patient may require a vein graft, which is harvested from elsewhere, usually the leg, similar to a coronary bypass surgery.
Extracranial to Intracranial (EC-IC) Bypass
This is a specific type of cerebral revascularization that involves dissecting the superficial temporal artery (STA) from the scalp, and 'plugging it in' to a brain vessel, usually a branch of the middle cerebral artery (MCA). These grafts directly provide new blood flow to the ischemic area of brain, and may reverse the symptoms that are occurring (Figure 2). They may also prevent stroke, although this conclusion is somewhat controversial. A large study completed in the early 1980's assessed the surgery's ability to prevent stroke, but findings indicated that it did not prevent stroke. The conclusion of this study led to Medicare and insurance companies no longer providing reimbursement for this procedure. As a result, very few surgeons today know how to perform it. Currently, however, new efforts were initiated to organize an updated study to evaluate the results of this procedure for stroke prevention.
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