'Rapid response' operation carried out within 24 hours of suffering a mini-stroke cuts risk of another episode by a thirdSurgery offered to patients within 24 hours of a 'mini-stroke'Carotid endarterectomy operation cuts risk of new stroke by a third
21:57 GMT, 2 March 2013
22:57 GMT, 2 March 2013
Rapid response: How the operation is carried out
Patients who have suffered a mini-stroke are now being offered ‘rapid-response’ surgery to prevent the condition worsening and leading to a full stroke.
Until now, those who have had a transient ischaemic attack (TIA) would not be considered for surgery until weeks later.
But new research has found that operating to unclog the affected blood vessels in the neck within 24 hours of having a TIA means a third do not go on to suffer another episode.
Treating TIAs as an emergency is similar to the approach to first heart attacks. In those cases immediate surgery to unblock cardiac arteries has cut deaths by almost a quarter.
TIAs occur when there is a temporary blockage – such as a piece of cholesterol or a clot – in the carotid arteries that supply the head, limiting blood and oxygen to the brain.
Symptoms include dizziness, slurred speech, temporary loss of consciousness and even paralysis. It is often a warning that a major stroke is imminent.
About 150,000 Britons suffer a stroke each year, and of those 45,000 are caused by carotid artery disease.
It is the third most common cause of death after heart disease and cancer, and the brain damage resulting from stroke is the largest cause for adult disability in the UK.
The operation, known as carotid endarterectomy, is carried out under general anaesthetic and involves a 5in incision into the neck to reach the affected artery. There are two carotid arteries, one on either side of the neck.
In some cases just one artery needs to be operated on but in more serious cases both will be. It can take up to 45 minutes to reach the artery and once identified it is clamped to stop blood flow. The other artery can maintain an adequate blood supply to the brain on its own for a short period.
The surgeon dissects the blood vessel and removes layers of plaque, which can build up over time due to genetic and lifestyle factors, reducing the diameter of the artery.
Saving surgery: The operation, known as carotid endarterectomy, is carried out under general anaesthetic and has cut the number of deaths by nearly 25 per cent
Mr Paul Flora, a vascular surgeon who heads a rapid intervention team for stroke patients at Barts and the London Hospital Trust, says: ‘This part of the operation is relatively quick because the fatty deposits that cause the narrowing are soft. It usually takes no more than 15 minutes.’ The artery is then sewn up, the clamps are removed and circulation restored.
Ninety-four per cent of TIA sufferers
at Barts receive carotid endarterectomy within 14 days, compared with
49 per cent nationally.
Its rate for disability following stroke is also low at three per cent compared with 11 per cent nationally.
One patient to have benefited is taxi driver Alan Cakebread, 61, of Woodford Bridge, Essex, who was operated on within 36 hours of suffering a TIA last year.
‘Due to my job, I ate on the go, usually unhealthy fast food,’ he says.
‘I had high cholesterol but didn’t take it seriously and I had no idea it could cause a stroke. It was quite a shock seeing the scan which showed how narrowed my arteries were.’
He recovered well from the operation, and in September he had a second procedure on his right carotid artery.
Today he is working again but the whole experience has been life-changing.
‘My diet is now very different. I’m so lucky I didn’t have a full stroke that could have killed me,’ he says.
Mr Flora adds: ‘Carotid surgery is not risk-free. There is a two to five per cent chance of suffering a major stroke or dying if a fatty deposit or clot breaks away during surgery. But patients are 30 per cent less likely to suffer another attack if the operation is a success.’