Carotid Endarterectomy: Complete Overview of Carotid Artery Surgery

Carotid artery disease is a condition, which results in the narrowing of carotid arteries. This artery supplies blood to one of the most critical organs, the brain. It can give rise to significant health risks, including an event of a stroke. Carotid endarterectomy, a surgical intervention, aims to address this issue by removing the plaque build-up within these arteries, thereby reducing the likelihood of the stroke and improving overall blood flow. On this page, you can look into the intricacies of carotid endarterectomy, exploring its procedure, advantages, risks, and long-term management.

What Is Carotid Endarterectomy?

Carotid endarterectomy is essential for combating the adverse effects caused by the accumulation of fatty deposits in carotid arteries. It restricts the normal functioning of the arteries located on both sides of your neck. An increase in atherosclerosis reduces the amount of blood flow towards the brain and increases the rate and risk of stroke.

While going through this procedure, you will be administered either a general or local anaesthetic. The surgeon cuts through your skin and makes a small incision in the front side of your neck, locates the carotid artery, and gets rid of the fat deposit, which causes blockage. The artery is then repaired using a patch made from a vein or artificial material or simply by stitching. Another technique, commonly known as eversion carotid endarterectomy, may also be employed, involving the cutting and inversion of the carotid artery to remove the plaque before reattaching the artery. The surgery helps improve blood flow by restoring the normal functioning of your carotid artery.

When is Carotid Endarterectomy Recommended?

It’s necessary to realise that the decision to have this treatment done is not only based on how severely the artery is blocked. To determine whether you are suitable for carotid endarterectomy, your surgeon will thoroughly examine your condition. Carotid angioplasty with stenting is an alternate method of treatment when carotid endarterectomy is not considered the best course of action. During this procedure, doctors utilise a long hollow tube, called a catheter, equipped with a small balloon, which is carefully threaded through a blood vessel in your neck and into the narrowed artery. The balloon is then inflated to widen the artery, and in many cases, a metal mesh tube called a stent is inserted to reduce the likelihood of the artery narrowing again.

Process of Carotid Artery Surgery

The process of carotid endarterectomy (CEA) typically involves the following steps:

Before the procedure:

• Remove any jewellery or objects that might greatly interfere with the surgical process.
• Change into hospital wear.
• Clear your bladder.

Preparation

• A healthcare assistant will initiate an intravenous (IV) line either in your hand or in your arm for medication and fluids.
• The professional will place a catheter in the wrist to monitor blood pressure and to take blood samples.
• Additional catheters can be inserted in your neck or under the collarbone for monitoring.
• The healthcare provider will shave the hair in the surgical part if necessary.
• Lie down on your back on the operation table with your head slightly raised and tilted away from the operated side.
• The healthcare professional will insert a catheter to drain the urine from your bladder.
• The anaesthesiologist should monitor your vital signs at the time of surgery.

Anaesthesia Options

• Carotid surgery may be performed under anaesthesia, where you won’t feel the surgery; you will be drowsy. You may receive a sedative through the IV for relaxation.
• If done under anaesthesia, the doctor will provide support and administer pain medication as needed. You will receive oxygen through a nasal tube.
• As an alternative, a general anaesthetic is used during carotid surgery, putting you to sleep. An oxygen tube will be inserted in your neck to help with ventilation.

Procedure Steps

• You will be administered antibiotics through the IV to prevent infection.
• Your skin on the surgical area will be cleaned with an antiseptic.
• Over the unhealthy artery, a side neck incision will be created.
• Accessing the artery will be possible through the cut.
• If necessary, by using a shunt, your surgeon will divert the flow of blood around the surgical area and maintain blood flow towards the brain.
• They will clear the artery of the plaque while the blood flow is diverted.
• After that, the shunt will be removed while carefully closing the artery. Your surgeon will stitch the neck incision.
• A small drainage tube will be positioned in the neck, if required, to collect any blood.
• You will be administered blood pressure medication through the IV as needed.
• If under general anaesthesia, you will be woken in the OT to assess responsiveness.
• In the last step, the doctor will apply a clean dressing or bandage to the surgical site.
  It’s significant to note that depending on personal circumstances and medical provider preferences, the procedure’s precise details may change.

Recovery and Post-Operative Care

After the carotid artery surgery, your recovery area will be closely monitored. Your healthcare team will diligently oversee your heart rate, blood pressure and general condition to ensure a smooth recuperation. There is a possibility to spend a night or two in the medical facility for observation purposes.

• Monitoring and Medications

Following the carotid endarterectomy surgery, your healthcare team may prescribe medications to prevent blood clot formation, lower blood pressure, or manage pain. Regular check-ups and imaging tests will be scheduled to monitor your recovery progress and assess the efficacy of the procedure.

• Rehabilitation and Follow-Up

The healthcare provider might suggest particular physical therapy and modifications to your lifestyle during the healing phase to improve your overall health. This can involve improving your diet and taking the initiative to stop smoking. Regular sessions will be set up to evaluate your progress in health and solve any problems you might be experiencing.

Advantages of carotid endarterectomy surgery

Carotid artery disease surgery offers several advantages for individuals with carotid artery disease. By removing the plaque, this surgical procedure reduces the stroke’s risk, improves blood flow to the brain, and alleviates speech and fatigue symptoms. Consequently, it can greatly enhance the patient’s quality of life while diminishing their dependence on medications.

Potential Risks

While an effective surgical treatment carries potential risks and complications that patients should be aware of. The risks include stroke or transient ischemic attack, heart attack, swelling caused by pooling of blood around the site of incision, and nerve problems affecting certain functions of the nose, eyes, ears, or tongue.

Patients need to be vigilant regarding the possibility of recurrent or emerging blockages in the carotid artery. Care should be taken in order to address issues such as bleeding at the site of the incision, infections, high blood pressure, irregular heartbeats, and breathing obstruction from swelling or bleeding in the neck. It is crucial for patients to remain cautious and informed about these potential concerns. It is important to communicate any allergies or sensitivities to medications, contrast dye, iodine, or latex to the healthcare provider. It is crucial to discuss any concerns or specific risks associated with an individual’s condition with the healthcare provider prior to undergoing the procedure.

How to reduce the risk factors?

Along with the surgery, adopting a healthy lifestyle significantly helps in managing carotid artery disease and mitigating the risk of future complications.

Control of Blood Pressure

Maintaining optimal blood pressure reduces significant risk factors for carotid artery disease and strokes. It is important to monitor and manage blood pressure through a good lifestyle and by taking prescribed medications as recommended by your healthcare provider.

Achieving a Nourishing Diet

Embracing a well-rounded eating regimen abundant in nutritious fruits, nutrient-packed vegetables, wholesome grains, proteins, and beneficial fats is highly recommended. An integral aspect of nurturing heart health involves curbing the consumption of saturated and trans fats, sodium, and processed edibles, ensuring a vital foundation for overall well-being.

Regular Exercise Routine

Consistent physical activity regimens amplify cardiovascular wellness, facilitate weight control, and cultivate a holistic state of being. The body and mind are both revitalised by engaging in delightful activities like peaceful strolls, swimming, or bike excursions as a part of your regular routine.

Shunning Tobacco and Limiting Alcohol

Tobacco usage and excessive alcohol consumption elevate the propensity for complications and hasten the deterioration of carotid artery health. By renouncing tobacco and moderating alcohol intake, you can profoundly transform your well-being in a positive manner, forging a path towards enhanced health outcomes.