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Carotid endarterectomy is a procedure performed to unblock arteries to the brain. The main purpose of this operation is to reduce stroke risk.
This procedure can be done either under local or general anaesthesia. When done under local anaesthesia, a number of local anaesthetic injections is given to the side of the neck. A mild sedative is also given. After preparing the field, the surgery begins by exposing the carotid artery in the neck. Heparin is then given to prevent blood clotting, and various clamps are applied. The carotid artery is then opened and in some patients, a shunt is inserted to ensure continued blood flow to the brain during surgery. After removing the occluding plaque, the carotid artery is cleaned from the inside and closed. Some patients may have a naturally small carotid artery. In these patients, an artificial patch may be required to widen the artery. Following closure of the artery, a drain is left next to it and the wound is closed. When performed under local anaesthesia, patients are usually engaged in short conversations and asked to perform simple tasks with their hands during the procedure. This is to ensure that the blood supply to the brain remains adequate at all times. It is possible that patients may feel symptoms similar to an impending stroke such as slurring or arm weakness and tingling. These symptoms are transient and alert the surgeon to the need for inserting a carotid shunt.
Once the operation is complete, movement of the contralateral side of the body is assessed. If all is well, patients are transferred to the high dependency unit where close monitoring of the blood pressure and neurological status takes place. Oral intake is usually allowed very early on after surgery. The drain is usually removed the next day.
Carotid endarterectomy is a delicate but generally well tolerated procedure. The most important complication is stroke. The incidence of perioperative stroke is 1-2%. This can range between mild weakness in one arm to complete paralysis of one side of the body to deep coma. Other complications include tongue weakness, difficulty breathing, neck bruising and numbness and the development of a heart attack.
Admission: Day before procedure Anaesthetic: Local / General Stay in hospital: 2-3 days Removal of sutures: 10-14 days Time off work: One to two weeks First follow-up appointment: 6 weeks |
The major arteries to the brain are exposed in the neck.
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