CAROTID ENDARTERECTOMY

GENERAL INFORMATION

Blood travels from the heart to the brain through 4 arteries in the neck, 2 carotid arteries and 2 vertebral arteries. A carotid endarterectomy is an operation in which a narrowed carotid artery is opened up to allow better flow of blood to the brain. The usual cause of this narrowing is a cholesterol deposit at the beginning of the internal carotid artery.


COMMON SIGNS AND SYMPTOMS
  • Sometimes the artery may be partially narrowed and there may be no symptoms at all.
  • If there is enough narrowing it may produce symptoms which last from a few minutes to a few hours - usually with complete recovery.
  • These symptoms may include weakness of the muscles of the face, arms or legs, usually on one side.
  • There may be slurred speech or a shade like blindness of one eye.
  • These attacks are called transient ischaemic attacks.


DIAGNOSIS
  • The diagnosis is usually made by taking a detailed history and a physical examination.
  • An arteriogram or a duplex scan may be done.


TREATMENT
  • Transient ischaemic attacks are a warning of impending stroke.
  • It is important to correct the narrowing before a stroke happens.
  • You have been advised to have an operation to open up a narrowed carotid artery.


PRE-OPERATIVE PREPARATION
  • Your doctor will advise when you need to be admitted.
  • Do not eat or drink anything for 6 hours before the operation.
  • Make sure your doctor knows what medicines you take, especially medicines which may affect blood clotting.


OPERATION
  • The operation generally takes 2 hours.
  • Your doctor will discuss whether he proposes to do this under general anaesthetic or local anaesthetic.
  • The carotid artery will be exposed through an incision on the side of your neck for the operation.


POST-OPERATIVE CARE
  • After the operation you will be taken to a recovery unit or high care unit where you will be kept until you are safe to be transferred to your regular hospital room.
  • Pain will be controlled with medicine.


COMPLICATIONS
  1. This disease is a high risk disease and this operation is a high risk operation. You must be aware of the following possible complications.
  2. Local damage to the nerves and other structure in the neck is possible.
  3. Post-operative bleeding is possible.
  4. An infection in the neck wound is rare.
  5. It is important to realise that it is possible that some or all of your symptoms might not be completely relieved by the operation.
  6. It is important to realise that there is a small incidence of stroke after this operation. When it does occur it is a disastrous complication. In extreme cases it may even lead to death.
  7. It is possible that the disease may recur and cause further narrowing of the artery. What is more common is that the same disease narrows the artery on the other side.
  8. Systemic complications like deep vein thrombosis and pulmonary embolism are possible after any operation or anaesthetic.