Carotid Artery Disease & Endarterectomy

About Carotid Artery Disease...

The brain receives blood through four arteries: the right and left common carotid arteries (front of the neck), and the right and left vertebral arteries (back of the neck).
Slightly below the level of the lower jaw, the common carotid arteries split into two: the external carotid artery (brings blood to the muscles of the face and neck) and the internal carotid artery (the most important supplier of blood and oxygen to the brain).

 

 

Plaque, mostly made of cholesterol deposits, and/or blood clot can form in all arteries in the body. It often develops where arteries branch into two.
The plaque or blood clot can remain in one area where it causes a narrowing of the artery over time; or pieces can break off, travel to smaller arteries, and prevent blood and oxygen from reaching the tissue. When these plaques or clots develop in the internal carotid artery, the blood supply to the brain can be severely impaired and cause symptoms of stroke.

What are the Common Signs and Symptoms?

• Some symptoms are on the opposite side of the body because the right brain controls the left side of the body.
• Symptoms can last from a few seconds to a few hours, and include:
• Weakness or paralysis of the muscles of the face, arm or leg on one side.
• Inability to understand people.
• Slurred speech or inability to speak.
• Shade-like blindness of one eye.
• If these symptoms last less than 24 hours, the event is called a Transient Ischemic Attack (TIA), and the person will likely recover all functions after the episode is complete.
• If these symptoms last more than 24 hours, the event is called a stroke and there may be permanent loss of the use of an arm, leg or speech. Partial recovery may occur over time and with rehabilitation.
• Sometimes a seriously narrowed artery may not give any symptoms. However, studies have shown that the risk of stroke with a seriously narrowed artery and no apparent symptoms is still about 10% within 5 years. A carotid endarterectomy would reduce the risk of stroke in that case to about 3% within 5 years.
• If a patient has symptoms, the risk of stroke is 25%.

How is Carotid Artery Disease Diagnosed?

• Usually, the diagnosis is made when any of the symptoms described above occur. During a physical examination, your doctor may hear a noise in your neck called a bruit, which is caused by the rush of blood through the narrow part of the diseased artery.
• The simplest, safest and most common way to look at the carotid and vertebral arteries is with ultrasound. This technique uses sound waves to form images of the inside of the artery, and detect the speed of the blood flow through narrowed areas.
• This test can be performed in our office.
• Sometimes the ultrasound test cannot provide all the answers, and the doctor may order an MRA or an angiogram to be done at the hospital.

How is Carotid Artery Disease Treated?

• A Carotid Endarterectomy is a surgical operation performed to “clean out” the diseased internal carotid artery. This procedure is recommended when a person has a narrowing causing symptoms, or when the narrowing becomes serious enough to significantly increase the risk of stroke.
• This operation is done strictly to prevent a stroke from happening. It will not reverse a stroke which has already occurred or improve any impairment that may have occured. However, it may prevent another stroke.
• TIAs (transient ischemic attacks) are a warning of impending stroke and bruits may indicate a higher risk for a stroke. It is important to correct the narrowing before a stroke happens.

How is the Surgery Performed?

• The surgery can be performed under local anesthesia with sedation (the area will be numbed and you will be given medication to relax you), or general anesthesia (you will be fully asleep).
• An incision is made on the side of the neck over the carotid artery. The artery is opened and the plaque removed. Sometimes a plastic tube, called a shunt, is put into the artery above and below the blockage to carry blood to the brain during surgery.
• After the artery is cleaned out, the incision is closed. Usually a patch is sewn over the opened area to maintain an even diameter.
• Sometimes a drain is placed into the incision. If this is the case, it will be removed the next day.
• The operation generally takes one to two hours. The hospital stay is generally overnight, with discharge the day after surgery.

What are the Possible Complications of Carotid Endarterectomy?

• Complications may happen as with any surgery. The major complication from this surgery is stroke (1 to 3% in patients with no symptoms pre surgery, and 3 to 5% for patients with symptoms before surgery).
• Another rare but major complication is bleeding into the neck wound, for which the patient may have to return to the operating room. Other possible problems include swelling in the neck, numbness and/or infection around the incision.
• It is important to remember that each person’s circumstances and medical history are different. One of our surgeons will discuss your options with you and make recommendations as to what course of action will be most beneficial to you.

Patient Instructions for Surgery

• Click here for Patient Instructions for Surgery...