Carotid Artery Surgery
What Can Cause a Stroke?
If blood flow to part of your brain stops, even very briefly, you may have symptoms of
a stroke or "mini-stroke".
A healthy carotid artery is open, allowing blood to flow to the brain. If the inside of
the artery becomes narrow and rough, a stroke is more likely to occur. Smoking, high blood
pressure, diabetes, increase blood lipids (fats) and other disease conditions can cause
narrowing and roughness and increase the risk of having a stroke.
Open Carotid Arteries (Normal)
- Inside of the artery is open and has no signs of narrowing
- Inside of the artery walls is smooth and healthy
- Blood flows from the heart to brain without any problems
- The brain gets all the blood and oxygen it needs
Narrowed Carotid Arteries
High blood pressure, diabetes and other health problems can cause a fatty substance
called plaque to build up on the inside of the artery walls.
- The path through the artery is narrowed by plaque buildup
- Blood clots can form the rough plaques
- Narrowed arteries can present some parts of the brain from getting enough
blood and oxygen to work normally
The Dangers of a Narrowed Carotid Artery
Tiny blood clots and bits of plaque can break off and travel through the carotid artery.
These are called emboli. Emboli can enter the smaller vessels in your brain. If the emboli
are large enough, they can block blood flow and cause a stroke.
If You Have A Mini-stroke (TIA)
Smaller emboli can briefly interrupt blood flow in parts of the brain. This causes a
"mini-stroke", also called a TIA (transcient ischaemic attack). It can last from a few
moments to a full day. TIAs are very serious. They can be a warning sign of a stroke.
Symptoms of a TIA and a stroke are the same. Get medical help right away.
If You Have a Stroke
Larger emboli can cut off blood flow to parts of the brain. This causes a stroke.
Without oxygen-rich blood that part of the brain dies. Symptoms after a stroke depend
on which part of the brain is affected. Some people have trouble walking after a stroke.
Others cannot speak. Sometimes stroke can kill. All strokes require emergency medical care.
Your Medical Evaluation
Your doctor will assess to learn more about your carotid artery problem. This may
involve numerous tests. The aim is to find out if surgery is needed.
Medical History and Physical Exam
Inform the doctor about your symptoms that include numbness, weakness, vision problems
and others. Also tell the doctor about your health problems like high blood pressure or
diabetes. The doctor will perform a physical examination including a neurological examination.
Duplex Ultrasound Tests
With the duplex scan images of the carotid arteries can be produced. A special probe is
gently pressed against the neck. An image then forms on a monitor and this shows how
severe the narrowing is.
Angiography
A doctor uses a special contrast “dye” that is injected and x-ray images are made of
the carotid artery. This tells you in more detail the site of narrowing in the artery.
Other Imaging Tests
These include magnetic resonance angiography (MRA) and brain imaging tests. MRA makes
an image of your carotid artery without using x-rays. Brain imaging tests can show damage
from a past stroke.
When Do You Need Surgery?
You and your doctor will discuss the best course of treatment. If you have a mild
narrowing but have had TIAs, you may need surgery. Even if you have not had any TIA
symptoms, your risk of having a stroke may still be high if one of your arteries is
severely narrowed. In that case, surgery may be needed.
Treatment Plan
If surgery is indicated, carotid endarterectomy will be needed. The surgery removes
plaque, reopening and smoothing your carotid artery. This reduces the chance of emboli
forming.
If you do not need surgery, your doctor may suggest lifestyle changes. Controlling
blood pressure, quitting smoking, eating healthier and exercising regularly can help
reduce your risk of stroke. You also may be given medication to help improve your blood flow.
Preparing for Surgery
Your doctor will tell you what you need to do. He will explain the main risks and
complications of surgery. Remember to ask about anything you do not understand.
Before surgery
- Tell your doctor about any medications you are taking (including aspirin).
Ask if you should stop taking them.
- If you smoke, try to quit before surgery.
- Do not eat or drink anything after midnight the night before surgery.
This includes water, chewing gum and breath mints.
- If your doctor tells you to take medication the morning of surgery, swallow it
with only small sips of water.
Risks of Complications
Like any surgery, carotid endarterectomy has certain risks and complications.
Some of these risks include:
- Bleeding
- Temporary trouble speaking or swallowing
- Heart attack
- Stroke
Your Surgery
In most cases, surgery takes no longer than two to three hours. You are likely to
spend a few days in the hospital. Bring personal care items and a robe with you. Leave
anything of value, such as jewelry, at home.
Checking In
You will be asked to read and sign a consent form when you arrive. This form explains
some details of your surgery. Your blood pressure and other vital signs also will be
taken at this time. An intravenous line may be started.
Anaesthesia
Anaesthesia prevents pain during surgery. A doctor trained in anaesthesia will explain
which type you will have.
General anaesthesia lets you "sleep" during the procedure. You will awaken soon after
surgery is done.
Local anaesthesia numbs the incision site so you do not feel pain during surgery. But
you remain awake. You also may be given medicine to relax you.
The Incision
A skin incision is made near one of the carotid arteries in your neck. The location and
angle are not always the same. Next, an incision is made in the artery itself.
Rerouting Blood Flow
Your blood may be rerouted for a short time with a shunt (small tube). The shunt allows
blood to flow to your brain while your doctor works on your artery.
Removing Plaque
The doctor carefully loosens plaque from the artery wall. The plaque is then removed.
With the plaque gone, the chance of emboli forming is greatly reduced.
Closing Up
If you had a shunt, it is removed. Your doctor then closes the artery with sutures
(stitches). Sometimes the arterial incision is patched with a vein from your groin. Next
the skin incision is closed with a small drainage tube. A bandage will cover the incision.
Recovering in the Hospital
After surgery, you will be taken to the intensive care unit for about a day. You may
later be moved to a regular hospital room. In many cases, patients go home within a week.
The First Few Hours
While in the intensive care unit, try not to move your head. It is normal to feel
some discomfort near the incision. But, medicine will help you feel better. You will
also have an IV to provide you with fluids. Your blood pressure, breathing and other
vital signs will be closely watched. Your loved ones may be able to visit with you soon.
As You Regain Strength
Expect to be up and walking again within 24 hours. If you had a drain, it will be
removed by a doctor or a nurse the day after surgery. Most patients spend at least one
night in the hospital. Your doctor will check you to see when you are ready to go home.
Back At Home
The following tips can help speed your recovery:
- Spend your first few days relaxing at home. You can read, watch TV or do other
quiet, restful activities.
- Take medications as instructed.
- Do not drive until your doctor says it is okay. This will most likely take a
week or two.
- Once your doctor says you can shower again, it is okay to get the incision area
wet. But do not scrub it.
- If you shave, be careful around the wound. You may want to use an electric razor.
When to call your doctor:
- Your neck swells
- There is oozing from the wound
- An arm or a leg becomes numb or weak
- You have sudden changes in vision or loss of vision in one eye
- You have difficulty speaking
Take Control of Your Health
You need to make healthy lifestyle choices. These choices can reduce your risk of having
a stroke.
Stop Smoking
Quitting smoking can lower blood pressure and help make your arteries healthier.
Here are some tips that may help:
- Join a quit-smoking support group
- Talk to family members or friends who have quit
- Talk to your doctor about trying quitting aids such as nicotine
patches or gum
Healthy Eating
A low fat, high-fibre-diet can help keep plaque from building up:
- Eat at least five serving of fruits and vegetables each day
- Eat more whole-grain products, such as whole wheat bread,
brown rice or oatmeal
- Control your cholesterol by trying fat-free milk and lower-fat meats,
such as, skinless chicken breast or fish.
Be Active Regularly
Physical activity in your daily life can help reduce your risk of stroke:
- Take about three 10-minute walks each day
- Join a small-walking club
- Go for a swim
- Ride a bike around your neighbourhood
Managing Health Problems
Talk to your doctor about the best ways to manage any health problems you may have. Your
doctor can help you with the following:
- High blood pressure
- Diabetes
- Heart disease
- High cholesterol
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