Is carotid artery reconstruction mandatory?

The risks and benefits of carotid artery sacrifice should be carefully weighed in every patient individually. The balloon test occlusion with CBF measurement is an important part of the decision process and can guide the surgeon regarding the treatment options most suitable in a particular situation. Although a patient may tolerate temporary occlusion with no CBF disturbance, there is a small risk of stroke on carotid sacrifice. Once the patient suffers a stroke, there is little that can be done. Therefore, if carotid sacrifice is deemed necessary in a patient, some type of revascularization should be considered. Revascularization should be performed with meticulous attention to detail, because it is not without risk. Intraoperative neurophysiologic monitoring and intraoperative arteriography are important adjuncts in such operations.