CAROTID ARTERY SURGERY

Narrowed Carotid Arteries:
Carotid arteries are large blood vessels that carry oxygenated blood to your brain. If you have narrowing of one of these arteries, your brain may not receive enough oxygenated blood. This may lead to a condition named ‘stroke’.

STROKE DIAGNOSIS:
Strokes occur due to cessation of blood flow to a certain region in the brain. There are approximately 250,000 strokes in the United States every year and carotid artery blockages are one of the major cause of strokes. Although styokes may be temporary, most of the time they are permanent. The most common signs of stroke are weakness or numbness in the upper or lower extremities, sudden changes in vision or complete blindness in one eye, garbled speech and facial asymmetry.

DECRAESING POSSIBILITY OF STROKES:
Carotid endarterectomy is a term used to describe the surgical procedure to open the narrowed carotid arteries in the neck. If you had a recent stroke, you may need immediate surgery. If you do not have any symptoms, your doctor might elect to wait a few weeks before recommending surgery. This will depend on the degree of narrowing in the carotid arteries. 200,000 Patients undergo operation for blockages of the carotid arteries every year in the US.

WHY DO STROKES OCCUR?:
A healthy carotid artery will ensure uninterrupted blood flow to your brain. If you have blockages in your carotid arteries, you may have a temporary or a permanent stroke. Tobacco use, diabetes, high cholesterol and like disease processes may lead to blockages of the arteries. Tobacco use and unhealthy diet may accelerate atherosclerosis.

Atherosclerosis will lead to narrowing of the arteries which in turn will decrease the amount of blood flow to brain and increase the chance of blood clots in the artery. Calcium and fat deposits may also dislodge from the arterial wall and can be washed into the small arteries in the brain. This will lead to brain infracts and may cause temporary or permanent strokes. The symptoms of the stroke will depend on the location of the occluded blood vessel. Some patients may experience difficulty in walking; some may have trouble with speech. Stroke may also lead to coma and death.

NECESSARY EXAMINATIONS:
The surgeons will perform a detailed history and physical examination. It is very important to provide all details your past illnesses and medication list. The blocked artery may generate an abnormal sound called ‘bruit’ due to changes in the blood flow pattern at the site of narrowing. The doctors will also evaluate your reflexes and strength as well as presence or absence of any spots in your eyes which may be harbingers of past small strokes.

Doctor Survey:
It may be necessary to run several tests to obtain detailed information regarding the degree of blockage and to decide whether you will need surgery to correct the problem. A Doppler Ultrasound examination will determine the degree of narrowing in the artery using sound waves and project it on a television screen. An angiography is sometimes performed. This test entails injection of contrast material (dye) into the artery and a road map of the blockages is generated. Magnetic Resonance Angiography can identify the arterial anatomy without X-Rays or radiation. A computerized tomography scan may be requested to identify any past strokes.

Is the surgery required?
The degree of narrowing in your artery as well as the presence or absence of symptoms will determine whether you need surgery to correct the problem. Your doctor may occasionally want to observe the blockage for some time before proceeding with surgery.

When the surgery required?
Your surgeons will sometimes recommend surgery even you have no complaints when there is severe blockage of the carotid artery since this condition is known to be associated with a high risk of stroke. Although surgery is reserved for rather severe stenosis, it may also be recommended for lesser degrees of carotid artery narrowing if you have history of transient strokes in the past.

Treatment Plan:
If you need surgery, your surgeon will most probably recommend a procedure called ‘carotid endarterectomy’. This surgery entails cleaning the calcium and fatty deposits and blood clots in the carotid artery to recreate a normal size blood vessel with smooth and clean surface. This will decrease the chance of formation of blood clots inside the artery.

If immediate surgery is not recommended, your doctor may recommend some medical measures to decrease the risk of stroke. These are control of hypertension, cessation of tobacco use, adopting a healthier diet and regular exercise. You may also be prescribed medications that will make blood thinner and enhance flow in the narrowed blood vessels and reduce the risk of thrombosis.

PREPARATION FOR SURGERY:
Do not forget to bring a complete list of your medications to the hospital before surgery. It is very important to quit smoking prior to surgery if you are a smoker. Do not eat or drink anything after midnight on the day of surgery. Take your medications with a sip of water if recommended to do so by your doctor on the morning of surgery.

CERTAIN RISKS AND POSSIBLE COMPLICATIONS:
Carotid endarterectomy has certain risks:
-Bleeding
-transient difficulty in speech or swallowing
-heart problems
-temporary or permanent stroke

Anesthesia:
The anesthesiologist will ensure a painless operation. The procedure may be performed using general anesthesia or local anesthesia. You will be awake in the latter however the operative site will be anesthetized.

Incision:
Incision will be right on the carotid artery. The length and location might change in every patient due to extent of blockage and body habitus. Your surgeon might elect to place a special tube in then artery at the time of the procedure. This will ensure continuation of blood flow to your brain at the time of surgery. The calcium and fatty deposits will be peeled off from the inner wall of the blood vessel. The aim is produce a large enough and smooth artery and prevent blood clots.

After Surgery:
The surgery will typically last about two hours. You will be taken to the intensive care unit where you will spend the night. It is normal to have some pain at the site of the surgery. You will have intravenous catheters and several monitors to check your pulse and blood pressure.

Hospital stay is usually one or two days. Your doctors will make the decision for discharge from the hospital.

After Discharge:
You should start to feel better in a couple of days after discharge and you can return to your usual daily routine in a week. Take your medication exactly as prescribed. Do not drive until recommended by your doctor (usually 1 week). Wash the surgery site with warm water and soap when instructed to shower. Do not scrub the incision.

When should you call your doctor?
Notify your doctor immediately if you develop sudden swelling at the site of the incision, drainage from the wound, weakness or numbness in the hands or feet, sudden loss of vision in one eye, difficulty with speech.