Carotid Endarterectomy Procedure and Complications
Carotid arteries are the two main blood vessels found in the neck. These carriers are predominantly responsible for providing oxygenated blood to the brain, face and scalp. The carotid arteries are located on either side of the neck and are divided into the external carotid and the internal carotid.
While these arteries function in the same manner as any other vessel in the body, what makes them so important is their direct connection to the brain.
Any obstruction in these arteries is fatal because it can lead to instant damage to the brain cells and tissues. Patients who have a blockade in the carotid arteries are known to suffer from carotid artery disease. In this context, carotid endarterectomy is a surgical process through which carotid artery disease is treated.
Carotid endarterectomy, commonly known as artery cleaning surgery, is performed when a patient’s carotid arteries are filled with plaque, making it hard for blood to flow through them. This plaque is made up of fats, cholesterol compounds, calcium, debris and dead white blood cells; and sticks to the inner lining of the arteries. Not only this, carotid plaque erodes the endothelium, causing occlusion and stenosis of carotid artery.
Carotid Endarterectomy Procedure
A carotid endarterectomy becomes a necessity when the plaque collection has grown to an extent that the brain is deprived of fresh blood and oxygen. Many a times, the same plaque also ruptures and breaks away from its origin, causes a blood clot. In other instances, the plaque travels in the blood to the small arteries of the brain and gets deposited in their lining.
In both these cases, the chances of suffering a stroke are extremely high. Using carotid endarterectomy, doctors cannot only prevent the onset of a stroke, they can also pre-empt the irreparable damage caused to the body as a whole. However, carotid endarterectomy is not performed on just about every patient with carotid atherosclerosis.
If the occlusion and stenosis of carotid artery seems small and controllable, patients are advised to bring positive changes to their lifestyles that include a healthy diet and regular exercising. On the other hand, if plaque accumulation has become fatal, carotid endarterectomy is the best option forward. It is performed if:
• Occlusion and stenosis of carotid arteries is at least 70%.
• Patient has suffered one or more mild Ischemic strokes in the last 6 months.
• Patient has a low risk of carotid endarterectomy post op complications.
What should patients expect when they are about to undergo an artery cleaning surgery? It helps to understand and make sense of carotid endarterectomy before one goes through it. The process itself lasts up to one hour and requires a patient to be sedated using anesthesia. The following steps are followed in a carotid endarterectomy:
1. The surgeon makes a small incision in the neck, just below the jaw line. This is exactly where the carotid arteries are located.
2. Once the affected artery is exposed, the blood flowing in it is rerouted. A tube is placed above and below the narrowed part of the artery, enabling blood to flow around the obstruction. This process is called shunting.
3. The blood vessel is then opened to reveal the plaque causing the occlusion and stenosis of carotid artery that is scrapped out in one piece.
4. Next, the shunt is removed and both incisions are sealed up- completing the artery cleaning surgery.
After the carotid endarterectomy is completed, the patient is usually kept under observation for a night, after which the slow healing process begins. According to doctors, it can take up to 2 weeks for the neck to heal completely, after which extremely strenuous physical activities are to be avoided.
Risks of Carotid Artery Surgery
While the steps involved in carotid endarterectomy are simple, their effectiveness depends on the condition of the patient. For instance, if a patient has a number of other ailments like heart or kidney disease along with a high chance of suffering a stroke, carotid endarterectomy may become risky. There are a number of carotid endarterectomy post op complications that are considered before a patient is taken into surgery.
Some of the risks of carotid artery surgery include the following:
• Injury to nerves. When the patient is operated upon, there is a chance of damaging the surrounding nerves. This can cause sensory problems post surgery.
• Infection. Any surgical procedure is associated with the risk of infection. The same is the case with a carotid endarterectomy.
• Bleeding inside the brain. Bleeding is the brain is a prominent cause of stroke, which can be heightened if the carotid endarterectomy does not go as planned.
• Vocal cord paralysis. Another risks of carotid artery surgery, vocal cord paralysis results when the nerves and sensitive tissues of the brain (that control vocal function) are affected by the surgery.
• Heart attack. If the flow of blood from the shunt is not redirected to its original route, the chances of a heart attack are high because of high blood pressure.
• Breathing problems.
Apart from the degree of blockade, the risks of carotid artery surgery also depend upon the expertise of the doctors and surgeons treating a patient. If the patient has already suffered ischemic strokes it is recommended that extreme care be taken before, during and after a carotid endarterectomy.
If a patient has a known heart condition, with high blood pressure, it needs to be controlled before carotid endarterectomy can be performed because any changes in the flow and direction of blood can become tedious for the heart if it is already weak or has an abnormal pumping pattern. In the same context, medications and doses given for such conditions need to be bought to attention.
Moreover, medical experts also suggest that the carotid endarterectomy be performed no more than 2-3 weeks after an ischemic stroke. According to research, the chances of suffering a dangerous stroke are higher in the first few days after the initial ischemic stroke. Therefore, timely action ensures that the risks of another stroke are lowered and further accumulation of plaque is avoided.