Carotid Endarterectomy

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About Carotid Endarterectomy

Carotid endarterectomy refers to a surgical procedure that is carried out unblock a carotid artery. The carotid arteries are the two important blood vessels that supply the blood to the head and neck.

Carotid endarterectomies are performed when one or both carotid arteries get narrowed due to an accumulation of fatty deposits (plaque). This is known as carotid artery disease or carotid artery stenosis.

If a narrowed carotid artery is left unattended, blood flow to the brain may be lowered. This is generally because a blood clot forms and a piece breaks off and goes to the brain. This can result in either:

  • a stroke – a serious medical condition that can cause brain damage or death
  • a transient ischaemic attack (TIA) – sometimes known as a "mini-stroke", a TIA is similar to a stroke but the signs and symptoms are temporary and usually disappear within 24 hours.

Carotid endarterectomy is found to significantly bring down the risk of a stroke in people with extremely narrowed carotid arteries. In people who have previously had a stroke or a TIA, their risk of having another stroke or TIA within the next three years is reduced by a third after surgery.

It's now thought the operation should be done at the earliest after the onset of symptoms. It's necessary to seek immediate medical advice if you experience symptoms such as:

  • numbness or weakness in the face, arm or leg
  • speech problems
  • loss of vision in one eye

The Procedure

Carotid endarterectomy can be performed by giving the patient either local anaesthetic or general anaesthetic. The benefit of local anaesthetic is it enables the surgeon to check brain function while you're awake. However, there's no proof that either is safer or better.

During the procedure, a 7-10 cm (2.5-4 inch) incision is made between the corner of your jaw and your breastbone. A small cut is then made along the narrowed section of artery, and the fatty deposits that have built up are removed. The artery is then closed with stitches or a patch and your skin is also closed with stitches.

Once the procedure is done, the patient is generally moved to the recovery area of the operating theatre for monitoring. Most people are well enough to go home within about 48 hours of the procedure.

However, there's a small risk of more serious complications, which can include stroke or death in around 3% of cases. Nevertheless, this risk is much lower than in people with carotid artery disease who haven't chosen to have the operation.

Carotid endarterectomy is the first choice treatment for the treatment of narrowed carotid arteries, but sometimes an alternative procedure known as carotid artery stent placement may be chosen.

This is a less invasive procedure as compared to a carotid endarterectomy due to no need of making a cut being made in the neck. Instead, a thin flexible tube is guided to the carotid artery through a small cut in the groin. A mesh cylinder (stent) is then placed into the narrowed section of artery to widen it and allow blood to flow through it more easily.

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