Carotid Endarterectomy and Carotid Stenting

When is carotid endarterectomy/stenting needed?

Carotid arteries are blood vessels located on either side of the neck. Atherosclerosis may affect arteries throughout the body. Sometimes this affects the carotid arteries causing accumulation of calcium or plaque inside the artery. Carotid endarterectomy or stenting may be recommended for people who have had a transient ischemic attack, or a mild stroke caused by significant carotid artery disease. For these patients, carotid endarterectomy or stenting may help prevent future strokes.

What is an endarterectomy?

An endarterectomy is a surgical procedure done to treat carotid artery disease. This is a disease that occurs when calcium or fatty, waxy deposits begin to accumulate in one of the carotid arteries.

The buildup of fatty, waxy deposits may prohibit blood flow from the heart to the brain. The removal of plaque may improve blood flow and reduce the risk of stroke. The human brain needs a constant supply of oxygen and nutrients, and a break in blood supply may lead to the brain not functioning properly.

What does an endarterectomy involve?

During a carotid endarterectomy, the patient will be under general or regional anaesthetic. An incision will be made along the front of the neck and on the artery that contains the plaque. All the important nerves in the area are identified and pushed aside to protect them. The plaque that is blocking the carotid artery will then be removed. During the procedure, the blood supply to the brain is monitored, and a shunt is inserted if needed. The vascular surgeon will repair the artery with the use of stitches and a patch to open and widen the artery and prevent restenosis. A drain will be inserted, and the wound will be closed with sutures. The incision site will then be dressed.

What happens after the procedure?

All patients are admitted to the High Care Unit to monitor blood pressure and reduce complications. Most patients will stay in the High Care Unit for 1 day and in the general ward for 1 day before discharge. The patient will follow up after 1 week for a wound check and then again after 1 month.

What is the carotid stent procedure?

A carotid stent is a minimally invasive procedure to treat carotid artery disease. The indications for carotid stenting are similar as for carotid endarterectomy. Narrowing of the carotid arteries due to plaque accumulation may lead to stroke or blindness in one eye. The purpose of the procedure is to reduce the risk of stroke/blindness.

What does a carotid stent procedure involve?

This endovascular procedure is performed under sedation and local anaesthetic in the Hybrid operating room. A cannula is placed in the groin into the femoral artery. Through this cannula, a catheter is inserted, and an angiogram performed to identify the area of narrowing and evaluate the circulation in the brain. A protection device is then inserted in the carotid artery to reduce the risk of stroke during the procedure. A special type of stent is then placed at the area where the carotid is narrowed, and it is opened with a dilatation balloon. An angiogram check confirms a positive result and the protection device and cannula is removed.

What happens after the stenting procedure?

All patients are admitted to the High Care Unit for 24-hour observation. This is done to control blood pressure and reduce complications. Most patients are discharged the following day. The patient will receive a blood thinner, and a follow-up appointment will be scheduled after a month.

How does the Vascular Surgeon decide which procedure should be done?

When deciding on which treatment option should be done, several factors will be considered to decide on a tailored treatment plan. Patient factors, disease factors and patient preferences are considered to decide which treatment option will have the greatest success rate. These will be discussed during the consultation.

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"Often healing takes place in ourselves as we pray for the healing of others."
~ Michael E. DeBakey