Carotid Endarterectomy is the name of the operation to clean out the artery to the brain. It is performed to prevent a stroke. The carotid artery in the neck is prone to the development of atheroma which is the name for the collection of fat and calcium which narrows arteries in the body. When little bits of atheroma break away and flow up to the brain, then depending on the size of the particle and where in the brain they lodge, either mini-strokes or a large stroke can occur. The commonest way that carotid atheroma is discovered is when an ultrasound scan is done because a noise is heard in the neck with a stethoscope. Thus most disease in the carotid artery is asymptomatic (silent).
When a mini-stroke occurs (called a TIA or Transient Ischemic Attack), then one can suffer transient loss of vision in one eye, weakness or pins and needles in the face arm or leg, or loss of speech. All these symptoms last for seconds to minutes, and may be repeated. If TIA's are experienced, then one is at a high risk (25%) of subsequent stroke in the next 2 years if the narrowing in the carotid artery is >70%. If the carotid atheroma is asymptomatic and >60% narrowed, the stroke risk is small (3% per year).
All patients should be treated with optimum management of the underlying risk factors which are smoking, hypertension and cholesterol. All patients should be on an antiplatelet agent such as Aspirin or Plavix, and this must continue after the operation.
Surgical treatment:
Carotid endarterectomy involves a general anaesthetic in my practice, and will require a hospital stay of 2-3 days. You will be sent to intensive care postoperatively. During the operation, the carotid arteries are clamped, opened up and cleaned out. The artery is closed with a Dacron patch to prevent narrowing it, and blood is supplied to the brain during the operation via a plastic shunt. Blood thinning agents are used during the operation to prevent clotting.
Complications:
These are uncommon. The most important is a stroke, which can occur during or after surgery, from platelet clot or debris dislodging from the cleaned portion of the artery. My combined stroke and death rate over the past 5 years is 1.9% in 155 patients. Reperfusion syndrome is a very rare event that occurs at 7-10 days postoperatively, and can cause headache, seizures or a cerebral haemorrhage, which may be fatal. Cranial nerve injury is another complication, which involves trauma to nerves in the neck that control the movement of the tongue (12th cranial nerve), the vocal cords (10th), movement of the corner of the mouth (7th), swallowing (9th & 10th), and the muscles of the shoulder and neck (11th). These are also uncommon injuries and if they occur are usually temporary. All patients will experience numbness in front of the incision and sometimes the earlobe, because this incision divides the skin nerves. This improves to a varying degree with time.