Carotid Endarterectomy

The carotid arteries are the main blood vessels that carry oxygen and blood to the brain. In carotid artery disease, these arteries become narrowed. This reduces blood flow to the brain and could cause a stroke. Carotid endarterectomy (CEA) is surgery to treat carotid artery disease. During a carotid endarterectomy, we can surgically remove plaque that builds up inside the carotid artery.

This is usually because a blood clot forms and a piece breaks off and goes to the brain. If a narrowed carotid artery is untreated, blood flow to the brain may be affected.

This can result in either:
a stroke – a serious medical condition that can cause brain damage or death

a transient ischaemic attack (TIA) – sometimes known as a “mini-stroke”, a TIA is similar to a stroke but the signs and symptoms are temporary and usually disappear within 24 hours

A carotid endarterectomy can significantly reduce the risk of a stroke in people with severely narrowed carotid arteries.

In people who have previously had a stroke or a TIA, surgery reduces their risk of having another stroke or TIA within the next 3 years by a third.

It’s now thought the operation should be carried out as soon as possible after symptoms appear.

It’s therefore important to get immediate medical advice if you experience symptoms such as:
– Numbness or weakness in your face, arm or leg
– Speech problems
– Loss of vision in one eye

Risk factors for carotid artery disease are similar to those for other types of heart disease. They include:
– Age
– Smoking
– Hypertension (high blood pressure) — the most important treatable risk factor for stroke
– Abnormal lipids or high cholesterol
– Insulin resistance
– Diabetes
– Obesity
– Sedentary lifestyle
– Family history of atherosclerosis, either coronary artery disease or carotid artery disease

Men younger than age 75 have a greater risk than women in the same age group. Women have a greater risk than men older than age 75. People who have coronary artery disease have an increased risk of developing carotid artery disease. Typically, the carotid arteries become diseased a few years later than the coronary arteries.

SURGICAL TREATMENT
A carotid endarterectomy is performed in a sterile surgical suite or standard operating room. The patient may go home the same day or stay 1–2 nights after the procedure depending on your medical condition.
– Patient receive a local anesthetic or general anesthesia.
– Vascular neurosurgeon makes an incision at the front of your neck.
– After removing the plaque from the artery your vascular surgeon repairs the artery by stitching in a natural graft (formed from a piece of vein from elsewhere in your body) or a woven patch.
– The incision is closed.

Carotid Artery Stenting (CAS)
It’s less invasive than carotid endarterectomy and is performed in a catheterization laboratory. With CAS, a small puncture is made in the groin. A specially designed catheter is threaded to the area of narrowing in the carotid artery. Once in place, a small balloon tip is inflated for a few seconds to open the artery. Then, a stent is placed in the artery and expanded to hold the artery open. A stent is a small tube that acts as a scaffold to provide support inside your artery

MEDICAL TREATMENT
We recommend antiplatelet medications such as aspirin and clopidogrel (Plavix) to decrease the risk of stroke caused by blood clots.