Transient Cerebral Ischaemic Disease in Pakistan: Does Carotid Endarterectomy Help?

Abstract

A study pertaining to a small series of patients suffering from surgical cerebrovascular disease is presented in this paper. Since the study was not scientifically controlled prospectively, the techic al charecteristics cannot be statistically generalise d. Although the series contained a very few numb er of patients, 50% were found to be suffering from hypertension, and 50% had additional cardiovascular disease. 100% were suffering from symptomatic TIAs, 50% had a past history of stroke and Carotid bruit was heard in 83% of the cases. All patients were indiscriminately shunted during endarterectomy (10 with Brenner’s shunt and 2 with tube shunt). One patient, additionally suffeTing from Takayasu’s disease died on the 9th post-operative day from secondary haemorrhage.

METHODS AND MATERIALS:

All of the patients were referred from other specialties and had reported symptomatic Tram sient Ischaemic Attacks (TIAs). The duration of symptoms varied widely. 12 patients were treated in this study. 11 were males with an average age of 55 years (40-70). 1 was female aged 35. All patients underwent doppler assessment for Carotid stenosis. Serial BPs measured in supine and standing positions and fasting and 90 minute post.prandial blood glucose levels constituted the main methods of categorising hypertension and diabetes respectively. Apart from symptomatic treatment, the most popular agents showing a positive benefit to the patient are Aspirin and Warfarin (61). Warfarin is however inferior to endarterectomy and also precipitates bleeding. Dipyridamole and Sulfinp yrazone have been extensively studied. A combination therapy has now largely been aban doned in favour of a low dose intermittent aspirin (62) which shows a positive improvement.