subject: Timing of Carotid Endarterectomy After Stroke ? [print this page] Timing of Carotid Endarterectomy After Stroke ?
Carotid Endarterectomy
Carotid endarterectomy is a protective procedure intended to reduce the risk of stroke, a vascular condition also known as a cardiovascular accident (CVA). In studies conducted by the National Institute of Neurological Disorders and Stroke (NINDS),
endarterectomy has proven to be especially protective for people who have already had a stroke, and for people who are at high risk for stroke or who have already been diagnosed with significant stenosis (between 50% and 70% blockage).
What is carotid endarterectomy?
Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow.
As you age, plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your carotid arteries, or to cause irregularities in the normally smooth inner walls of the arteries.
How do I prepare?
Your physician or vascular surgeon will give you the instructions you need to follow before the surgery, such as fasting.
Before your vascular surgeon performs a carotid endarterectomy, he or she may want to determine how much plaque has built up in your arteries. The most common test used for this purpose is duplex ultrasound. Duplex ultrasound uses painless sound waves to show your blood vessels and measure how fast your blood flows. It can also determine the location and degree of narrowing in your carotid artery.
Other tests your vascular surgeon may use include : -
* Computed tomography (CT) scan
* Computed tomographic angiogram (CTA)
* Magnetic resonance angiography (MRA)
* Angiography (or arteriography)
During carotid endarterectomy
* You will probably receive general anesthesia. This will make you unconscious and unable to feel pain. Some hospitals may use local anesthesia instead. With local anesthesia, only the part of your body being worked on will be made numb with medicine so that you will not feel pain.
* You will lie on your back on a padded operating table with your head turned to one side. The side that will face up is the side your blocked carotid artery is on.
* Your surgeon will make an incision (a cut) on your neck over your carotid artery. Your surgeon will put a catheter (a flexible tube) in place. Blood will flow through the catheter around the blocked area during surgery.
* Then your surgeon will open your carotid artery. The surgeon will then remove the plaque inside your artery.
* Your artery will be closed up with stitches after the plaque is removed. Blood will now flow through the artery to your brain.
* Your heart and brain activity will be monitored closely during your surgery.
In some cases, the disease can be detected during a normal checkup by a physician. In other cases further testing is needed. Some of the tests a physician can use or order include ultrasound imaging, arteriography, and magnetic resonance angiography (MRA). Frequently these procedures are carried out in a stepwise fashion: from a doctor's evaluation of signs and symptoms to ultrasound, MRA, and arteriography for increasingly difficult cases.
What to Expect ?
Before the operation, the physician cleans and shaves the skin on the neck to help prevent infection. The patient may be given a general anesthesia, or the patient may remain awake and given a local anesthetic to numb the neck area.
The surgeon makes an incision along one side of the neck and carries the incision down to expose the blocked carotid artery. Then the surgeon retracts, or draws back, the jugular vein, as well as nerves that lead to the ear, tongue and vocal cords. The sections of the common, external, and internal carotid arteries affected by plaque buildup are separated from surrounding tissue and are clamped to temporarily stop blood from flowing through them.
Once the arteries are clamped, the surgeon makes an incision, called an arteriotomy, directly into the section of the carotid artery that is blocked by plaque. During the time the carotid artery is open and clamped, blood does not flow through the artery. A temporary bypass (called a shunt) is often used to carry blood flow around the section of the artery that is being repaired. During the procedure, the brain gets its blood supply from the common carotid on the other side of the neck and other blood vessels.
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