Carotid Endarectomy versus Stent

by

Dr. G.N. Lakshminarayan

This 39 yrs old moderately obese woman reported to me a month ago with pain and cramps of the right side of the body of 10 days duration. Since she had lots of family problems and the symptoms was a positive one, I dismissed her saying she won’t develop a stroke. She lost her father 10 days later due to CRF. Four days ago,she was admitted to the hospital for weakness of the right side and slurring of speech of two days duration. MRA showed a thrombus in the left carotid bifurcation. She was managed conservatively when she showed improvement but yesterday she again developed more slurring of speech and weakness of the right side. The MRA was shown to an interventional radiologist who prepared to stent the left carotid. But after angiogram, he refused stenting saying it is dangerous because of the loosely lying thrombus and advised CEA. Promptly she was taken up for CEA which went on well. She is recovering. Antiphospholipid abs, rheumatology and cardiac workup, and clotting cascade are normal.

I only felt sad because it was me who assured her that she won’t develop a stroke.

Lakshminarayan

 

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(c) 2006 M.H. Rivner

revised 10/23/2006