Background
Carotid endarterectomy is a surgical procedure that results in the removal of atherosclerotic plaques situated in the arteries of the neck (the common carotid arteries), as a result of atherosclerosis which causes these plaques to form. The aortic arch emerges from the heart and then branches out to the left and right carotid arteries that supply blood flow to the brain and the hands. Plaque can build up on the inner surface of the neck (carotid) arteries and narrow or constrict the flow of blood in these arteries. Pieces of plaque, called emboli, can break off (embolize) and travel up the internal carotid artery to the brain, where it blocks circulation and can cause brain strokes.
There are many causes for brain strokes. As stated above, one of the causes is the narrowing of the carotid arteries which causes blood clots to travel up to the brain. In patients who suffer from a heart condition, diabetes and/or are at high risk for atherosclerosis (smoking, high blood pressure and hyperlipidemia) there is a 50% chance that they have common carotid artery atherosclerosis. This disease can be detected by undergoing a Doppler examination of the common carotid arteries. Further imaging will include computed tomography of the brain and sometimes also a computed tomography angiogram of the neck and the aortic arch arteries, in order to decide on the course of continued treatment and surgical intervention.
Treatment of carotid artery stenosis by medication alone includes the drugs aspirin and Plavix. Surgical intervention, called carotid endarterectomy, to reduce the risk of brain strokes, has been done for the last 50 years, and in the 90's was proven as significant in the prevention of brain strokes in symptomatic patients with severe stenosis (narrowing).
After a temporary or fixed brain stroke there is a very high risk for a secondary stroke during the weeks following the first stroke, and therefore quick intervention is crucial. There are also cases where carotid endarterectomy is performed on patients with severe stenosis (narrowing) but without the active disease (such as in young patients, bilateral disease etc.).
The course of the operation
Carotid endarterectomy is performed under general or local anesthesia and lasts on average for about two hours. During the operation actions are taken in order to maintain good blood flow to the brain while the plaque substance is removed from the artery. The patient receives medications for blood thinning and for balanced blood pressure. After all traces of atherosclerosis have been removed, the artery is closed either by sewing it up or by sewing an expending patch on to it.
Risks involved with carotid endarterectomy
One of the risks in undergoing carotid endarterectomy is a brain stroke. In asymptomatic patients the risk is less than1%, while in symptomatic patients the risk is between 2-4%. However, the risk for symptomatic patients who do not undergo carotid endarterectomy for a recurring stroke is much greater and can reach 20% and higher.
Other substantial risks include a low percentage of patients who are known to suffer from a heart condition and could have cardiac-related complications during the carotid endarterectomy. There must be a cardiac assessment and approval prior to surgical intervention.
Other common phenomena include blood pressure changes around the surgical area, and local hematoma in the neck.
Duration of recovery and hospital stay
Throughout the night following the surgery the patient will be under constant watch in the intensive care unit, after which he/she will be transferred to a ward and will be able to get out of bed and function independently. The average hospital stay is about two days, followed by a gradual return to normal activity.
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