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Can surgery prevent transient ischemic attacks?

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General & Family Physician
Practicing since : 2009
Answered : 299 Questions
My dad had a stroke, actually a TIA 3 months ago and his right vertebral artery is 100% blocked and left one is blocked a bit as well. He is 55 years old, and has hypertension and diabetes. Is there any possibility to have a surgery to get rid of the blockage or any other better treatments? Thanks
Thu, 12 Apr 2012 in Stroke
Answered by Dr. Vidya Muralidhar 2 hours later

Thanks for the query.

I understand what your dear dad is going through physically and psychologically.It is noted that most of the patients suffer from symptoms of depression after a stroke.

A history of diabetes and hypertension has chances of a recurrence of stroke.However, this does not mean that he will surely have an attack again.A good control of diabetes and high blood pressure will reduce the chances of stroke in the future.Life style modification, right diet and daily physical activity will surely be helpful.

Medical treatment is available for his condition. He will be benefited from blood thinners like aspirin and Clopidogrel. Antithrombotic drugs and anticoagulants have been proven to reduce the recurrence of stroke. A combination and Aspirin and Dipyridamole is very effective in reducing risk of recurrence.You may discuss these options with your doctor.

Surgical procedures like Carotid endarterectomy(CEA)is effective in patients with 70% to 99% stenosis without a neurological complication. This could be an option in your dad's case. You may discuss about this with your doctor.The decision purely depends on the patient's condition, associated risks and complications.The doctor examining him will be the right person to decide if this will benefit your father.

The dizziness post stroke has to be evaluated.His blood pressure and blood sugars have to be regularly checked and he must continue his blood pressure and diabetic medications

Meanwhile your dad must also seek a Psychiatric consultation and if needed counselling sessions and medications for depression may be started soon.

Hope this answers your query. I am available for follow ups as well.
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Follow-up: Can surgery prevent transient ischemic attacks? 26 hours later
Thank you for your answer, doctor.

For the surgical procedures, is there any side effects after the operation? Also, how does the surgery go? Could you provide some detials about the surgery? My dad is having thinner vessels than normal people because of some genetic you think the surgery will be too risky for him?
Answered by Dr. Vidya Muralidhar 3 hours later

Thanks for writing back.

I did my bit of research to answer your question. My view is an endovascular stenting of the 100% stenosed vertebral artery could be better than a surgical endarterectomy. However an interventional cardiologist would be much sure if this procedure can be beneficial in a person with thin walled vessel.

This has shown to be more simple and effective when compared to surgery.Percutaneous Transluminal Angioplasty(PTA) and stenting is a safe and effective treatment especially for the vertebral artery stenosis. The success rates are high and complications are very less. Chances of thromboembolism with the stents in place is also widely reduced.

Surgical procedure for a vertebral artery stenosis would be an endarterectomy or reconstruction. This procedure is done by an incision over the neck and needs great skills to be performed.The area of the artery or the inner lining around the artery which is blocked by plaque will be removed and the vessel will be re stitiched. Before a plan up there are many factors which may be needed to be assessed. Investigations like angiography, MRA, Transcranial Doppler Ultrasound may be needed.This procedure may take around 2 to 4 hours.This is a fairly safe procedure. Bleeding form vessels, short term nerve injury,numbness of face,vocal cord paralysis can be a part of the complications.

Irrespective of surgery or stenting, he must continue to take medications and follow a good diet and exercise regimen regularly.

Kindly discuss these options with your doctor and make a decision.

Wish you and your dad good health.
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