Carotid artery surgery

Carotid artery surgery

Definition

Carotid artery surgery is a surgical procedure to restore adequate blood flow to the brain.

Alternative Names

Carotid endarterectomy

Indications

The procedure may be used to treat symptoms of carotid artery blockage, such as:

• Weakness of the arm, leg, or face on one side of the body
• Inability to move the arm, leg, or face on one side of the body (paralysis)
• Numbness, tingling, or noticeable change in the sensation of the arm, leg, or face on one side of the body
• Difficulty swallowing
• Loss of all or part of vision (blindness) in one eye
• Slurred speech or inability to speak
• Dizziness (vertigo)
• Confusion, fainting, or coma
• Stroke with complete recovery (TIA)
• Severe blockage without any symptoms at all

Seek urgent medical attention if you experience these symptoms. The symptoms may be permanent, but even if they occur transiently and then get better by themselves (TIA, or transient ischemic attack), they still might be a sign of a serious problem.

Surgery should also be done for those who have carotid artery blockages which cut off between 75-99% of blood flow through this major artery. Large studies have shown that for people with such severe blockages, even if they have no symptoms at all, the risk of stroke is reduced with surgery.

If the blockage is complete (100%), however, surgery will not be performed because the risk of stroke and significant brain damage from the procedure is too great.

X-ray studies using special dyes (carotid angiogram) can show the degree of blockage of the carotid arteries. Other studies that can visualize blockages in the carotid arteries are ultrasound and magnetic resonance angiography (MRA).

Convalescence

After surgery, you are usually observed overnight to watch for any signs of bleeding, stroke, or compromised blood flow to the brain. However, there is a recent trend to send the patient home the same day, if the operation is done early and the patient is doing well.

Erratic blood pressure (requiring monitoring in an intensive care unit) is relatively common, tends to improve within 24 hours, and should not be a cause for concern.

Expectations after surgery

Carotid artery surgery usually helps prevent further brain damage and reduces the risk of stroke. However, unless lifestyle changes (like diet and exercise when approved by your physician) are made, plaque buildup, clot formation, and other problems in the carotid arteries can return.

Risks

The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection

Additional risks of carotid surgery include:

• Blood clots
• Brain damage
• Strokes (1-3% in the hands of an experienced surgeon)
• Heart attacks

Carotid stenosis, X-ray of the left artery

Carotid stenosis, X-ray of the right artery

Arterial tear in internal carotid artery

Atherosclerosis of internal carotid artery

Arterial plaque build-up

Carotid artery surgery - series

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