Carotid Artery Surgery, also called Carotid Endarterectomy, is done to treat a condition called Carotid Artery Disease or CAD. CAD can be dangerous and if diagnosed or treated late, it can cause brain attack or brain stroke. Carotid Endarterectomy is an incisional surgery and is a better option than the minimally-invasive option called carotid angioplasty with stenting. In this article, we will learn more about the condition and also the procedure.
The Carotid Artery is a prominent artery that supplies blood to the brain, from the heart. Two carotid arteries run, one on each side of the neck, to supply blood through a network of small and large arteries distributed throughout the brain.
Atherosclerosis is a condition in which cholesterol, calcium and fat start depositing on the walls of the carotid artery. Over time, the deposits harden into a material called plaque. Plaque deposits can narrow down the artery, and this condition is called stenosis. In addition to plaque, blood-clots may also accumulate at that spot. The stenosis restricts or reduces timely blood-flow to the brain. This is dangerous, and is similar to plaque deposition in the coronary artery of the heart which causes a heart attack. In this case, atherosclerosis of the carotid artery causes a brain attack, also called a stroke.
Over time, pieces of the plaque start breaking off and travelling through arteries in the brain. This can cause a serious blockage in narrow blood-vessels of the brain. Similarly, the blood-clots at the above spot can travel and block narrow blood-vessels in the brain and this condition is called embolism. Whether the blockage is caused by plaque or a blood-clot, the consequence is a stroke, more specifically called an ischemic stroke. Ischemic stroke is dangerous and can cause paralysis and serious disability in the person. That is why, it must be prevented in time through accurate diagnosis, and procedures such as the carotid endarterectomy.
Once the above tests confirm CAD in one or both carotid arteries, then the blockage must be cleared as soon as possible to reduce the risk of stroke. There are 2 options available:
Carotid Artery Surgery, also called Carotid End-arterectomy (CEA), is an incisional or open-surgery where surgeons access the carotid artery and remove the plaque and blood-clots that have caused a blockage. The procedure is generally done under general anaesthesia but if the patient is comfortable with it, local anaesthesia is also an option. CEA will be advised by doctors if the patient has already had a stroke, or TIA, or if he/she has blockage of the artery which is severe but not total.
The above tests mentioned under Diagnosis will be conducted to confirm CAD and also to know the extent. The tests will also help identify the blockage spot precisely. For a week before the procedure, the doctors may advise the patient to stop taking any medication. He/she must check into the hospital the previous night, and will not be allowed to eat or drink anything after midnight.
The patient is wheeled into the OR, and anaesthesia given. He/she must sleep on the side which is opposite to that which the surgeons must operate on. This way the carotid artery is easily accessible. Once the patient is no longer conscious, the doctors will clamp the carotid artery. The other carotid artery will be supplying blood to the brain. Further, the doctors may re-route the blood-flow around the artery that is being operated on.
An incision is made on the skin, above the precise spot of blockage. The carotid artery is cut gently, and the plaque and/or blood-clots removed using an assortment of tools. The normal blood-flow is restored now. The artery is then stitched back. The incision on the skin is sutured up. A tube is connected to the neck that helps drain out excess fluid.
The patient will remain in the hospital for 1 to 2 days during which, his vitals and neurological status will be closely monitored, after which he/she will be discharged. The patient must avoid lifting heavy objects, and refrain from driving, for up to 2 weeks after the procedure.
CEA comes with certain risks too.
In-spite of the above risks, CEA is widely preferred for its efficacy. The success rate is also good, which is encouraging. Carotid stenosis, or narrowing of the artery due to a blockage, is measured in percentage. That is, percentage of blockage in the artery.
(Source: National Institute of Neurological Disorders and Stroke (NINDS), affiliated to NIH, a govt-body in the US)
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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