WHAT ARE THE SYMPTOMS OF
CAROTID ARTERIAL BLOCKAGE ?
A disturbance in either one or
more of the following:
numbness, weakness and/or paralysis of one side of the body or an
Sight – temporary
blindness in one eye
Speech – difficulty
and/or the ability to swallow
It is also possible to show no
symptoms at all. Other symptoms can include:
Remember, these may also signal
possible brain hemorrhage.
WHAT IS CAROTID ENDARTERECTOMY
Two carotid arteries in the neck
carry blood from the heart to the brain. A stroke can occur when a
carotid artery becomes blocked as a result of the build-up of fatty
deposits (atherosclerotic plaque). Carotid endarterectomy is a
surgical procedure in which the atherosclerotic plaque is removed from
the carotid artery to reduce likelihood of stroke. Carotid
endarterectomy is one of the most commonly performed blood vessel
surgeries, although there is some risk that the surgery itself may
actually induce stroke. The incidence of this complication varies
among surgeons and medical institutions. Surgery is most
beneficial in carefully defined patients at centers that have a low risk
for surgical complication.
HOW IS CAROTID ARTERY DISEASE
The disease can usually be
detected during your regular check-up with a physician. The doctor
will ask about symptoms of a stroke, such as if you’ve experienced
numbness or muscle weakness, speech or vision difficulties or
lightheadedness. The doctor may hear a rushing sound in your
carotid artery through his stethoscope. Unfortunately, dangerous
levels of disease sometimes fail to make a sound and some blockages with
a low risk can make a sound, so it is possible to misdiagnose. The
doctor may choose to use various other tests to confirm or establish
diagnosis, such as:
Doppler ultrasound imaging
This is a painless, noninvasive
test in which sound waves are sent into the neck. Echoes from the
sound waves bounce off the moving blood and the tissue in the artery and
can be formed into an image, which the doctor can then view.
Ultrasound is fast, risk-free and painless. There is a very small
possibility, however, of an error in an ultrasound study.
Computed tomography (CT)
This test produces a series of
X-rays of the head and brain. It is not used to detect carotid
artery disease but may be ordered to investigate the cause of other
Arteriography and digital subtraction angiography (DSA)
Arteriography is an X-ray of the
carotid artery. It is taken by injecting a special dye into
another artery in the leg or arm. You may feel a burning sensation
when the dye is injected. DSA is also an X-ray study of the
carotid artery. It is similar to arteriography, but with DSA, less
dye is used. When you have a DSA, you mush remain still during the
test. It is important to know that these two procedures carry
their own small risk of causing a stroke.
Magnetic Resonance Angiography (MRA)
This imaging technique is more
accurate than an ultrasound and avoids the risks associated with X-rays
and dye injection. An MRA uses harmless but powerful magnetic
fields to create a highly detailed image of the body’s tissues.
WHO ARE THE BEST CANDIDATES FOR
CAROTID ENDARTERECTOMY ?
The surgery is most beneficial for
persons who have already had a stroke or who have experienced the
warning signs of a stroke and have variant degrees of stenosis (50-70%,
70-99%). Surgery can reduce the risk of stroke by more than
80-percent. Recent studies have shown the selected asymptomatic
patient with significant stenosis (more than 60%) can benefit from a
carotid endarterectomy by reducing the risk of stroke by at least
The general medical and
neurological condition of the patient and the experience of the surgeon
have a direct effect on outcome and should, therefore, be considered in
determining if a carotid endarterectomy is appropriate.
WHO IS AT RISK FOR STROKE ?
You are at the greatest risk for
carotid artery narrowing if you are over the age of 65 (particularly if
you smoke) and if you already have poor circulation in your legs or
heart. If you experience a lot of stress, are obese or consume
excess alcohol, you are also at risk.
HOW IS CAROTID ENDARTERECTOMY
This procedure can be performed
with general or local anesthesia. The advantage of local
anesthesia is that it is easy to monitor how the brain reacts to having
the artery closed during repair but there are also sophisticated
monitoring techniques used during general anesthesia.
The length of
time required for this procedure may vary depending on the complexity of
the repair required but it is usually completed within two hours.
The surgeon will make an incision in your neck over the obstruction
itself and the obstruction is scraped away. The opened area is
patched with a graft made from vein from another part of your body.
The skin is then closed with sutures or clips, which can usually be
removed within two weeks.
WHAT ARE THE POSSIBLE
Possible complications include:
Blood clot (hematoma)
Infection at the
site of the incision
Injury to nerves in
the face, vocal cord or tongue.
(transient ischemic attacks)
IS THE OPERATION BETTER THAN
DRUG THERAPY ?
A surgical procedure seems to
provide better protection against stroke than aspirin does in patent
with a carotid artery at least 70-percent obstructed. Blood
thinning drugs or oral anticoagulant drugs can reduce the risk of stroke
but only variably because they may also add to the trouble because of
bleeding complications. A successful carotid endarterectomy can
put an end to immobilizing strokes and transient ischemic attacks.
WHAT HAPPENS RIGHT AFTER THE
remain overnight in the Intensive Care area to watch for any
complication that may possible arise. If intravenous fluids were
administered during the procedure, then blood and electrolyte tests will
be performed in the ICU (intensive care unit). The heart will be
monitored by an electrocardiogram to verify that it is behaving
normally. Neurological examinations will also be given for
strength evaluation of your arms and legs, hand movements, speech, sight
and thought patterns.
No drugs, food or water will be
given orally for several hours or until the day following the procedure
so that the neck area can begin to heal. Thirst will be quenched
by sucking on ice chips. Aspirin therapy may start here and be
WHAT ABOUT RECOVERY ?
Most hospital stays for this procedure are short,
lasting on average two to three days, with about two weeks recovery at
home. An outpatient exam will be done after one month to evaluate
the brain function and how the wound is healing. After this exam,
a yearly exam will be scheduled.
WHAT IS THE PROBABLE OUTCOME ?
With a successful surgery, you
cane expect a complete healing without complications and a restoration
of good blood flow to the brain.