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Surgery for Stroke Prevention

Carotid Endarterectomy is a surgical procedure during which the vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged with fatty plaque deposits. This procedure eliminates plaque from your artery which normally builds up with age, to restore blood flow. This condition is known as Carotid Artery Disease.

Cholesterol, calcium, and fibrous tissue make up this plaque leading to narrowing and stiffening of your arteries called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your carotid arteries, or cause irregularities in the normally smooth inner walls of the arteries.

Carotid Artery Disease affects the 2 large carotid arteries vessels leading to the head and brain. Like the heart, the brain's cells need a constant supply of oxygen-rich blood. This blood supply is delivered to the brain vessels in the front of the neck and by 2 smaller vertebral arteries at the back of the neck. The right and left vertebral arteries come together at the base of the brain to form what is called the basilar artery. A stroke most often occurs when the carotid arteries become blocked and the brain does not get enough oxygen.

Carotid artery disease is a serious issue because clots can form on the plaque. Plaque or clots can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to your brain sufficiently, it can cause an ischemic stroke, which can cause permanent brain damage, or death, if a large enough area of the brain is affected. If a clot or plaque blocks only a tiny artery in the brain, it may cause a Transient Ischemic Attack (TIA), also known as a mini-stroke. A TIA is often a warning sign that a stroke may occur in the near future, and it should be a signal to seek treatment soon, before a stroke occurs.

Endarterectomy is the removal of material on the inside (end) of an artery. Angioplasty and stenting of the carotid artery are undergoing investigation as alternatives to carotid endarterectomy.

Diagnosis

The test used to determine blockages are:

  • Computed tomography (CT) scan
  • Computed tomographic angiogram (CTA)
  • Magnetic resonance angiography (MRA)
  • Angiography (or arteriography)

Carotid artery disease increases the risk for stroke in 3 different ways:

  • Plaque deposits severely narrowing the carotid arteries
  • A blood clot blocking the path narrowed by plaque
  • A portion of plaque breaking free from the carotid arteries and blocking a smaller artery in the brain

Symptoms

The specific warning signs of a stroke are a good way to tell if there is a blockage in the carotid arteries. Transient ischemic attacks (TIAs) are temporary episodes of headache, dizziness, tingling, numbness, blurred vision, confusion or paralysis that can last anywhere from a few minutes to a couple of hours.

Other symptoms may be

  • Dizziness, tendency to faint
  • Numbness or a tingling sensation or Partial paralysis or weakness of arm, leg or face on one side of the body
  • Difficulty in swallowing
  • Blurred eyesight in any one eye
BRIEF ABOUT THE PROCEDURE

The patient is put under general anesthesia and a suitable incision is made in the neck, at the location of the blockage. A tube is inserted above and below the blockage to bypass blood flow. TSurgery for Stroke Preventionhe carotid artery is then opened and the plaque is removed. The artery is stitched closed after this and the tube is removed. In certain cases alternate technique that does not require blood flow to be rerouted may be adopted where the blood flow is stopped just long enough to peel the blockage away from the artery./p>

Endarterectomy surgery is a proven treatment in providing long-term benefits to patients who have an asymptomatic carotid artery disease with more than 60% artery diameter reduction.

SOME ASSOCIATED RISKS

Carotid artery disease increases the risk for stroke in 3 different ways:

  • Plaque deposits severely narrowing the carotid arteries
  • A blood clot blocking the path narrowed by plaque
  • A portion of plaque breaking free from the carotid arteries and blocking a smaller artery in the brain
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