Carotid endarterectomy :

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.

Plaque primarily consists of Cholesterol, calcium, and fibrous tissues. This leads to narrowing and stiffening or hardening of the arteries. Eventually, plaque builds up to such an extent that blood flow gets reduced through the carotid arteries. This can 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.

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 include

• Dizziness or a 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 vision in any one eye

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. The 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.

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.

The usual tests done to detect any blockages are:

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

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

Recovery

After the surgery is done, the patient is shifted to the recovery room where he will be monitored to check for any signs of complications. Total hospital stay may be for 2 or 3 days. Normal activities may be gradually resumed.

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