Carotid endarterectomy is the earliest, safest and most effective treatment for carotid artery disease. Surgery may be required if the carotid artery disease is severe or has progressed from previous cases. Severe disease manifestations include a previous history of transient ischemic attack and cerebral infarction. When severe carotid artery stenosis exceeds 70%, surgical treatment is indicated even if asymptomatic.
Am I a candidate for carotid endarterectomy?
If you have severe carotid stenosis, especially if you have a history of transient ischemic attacks and are in relatively good health, you are a candidate for carotid endarterectomy. However, there are some risks if there is
Severe cerebral infarction that has not fully recovered
Patients with malignant tumors with an expected survival time of less than 2 years
Severe hypertension without regular control on weekdays
Unstable angina pectoris
History of cardiovascular accident within 6 months
Congestive heart failure
Progressive brain lesions, such as Alzheimer’s disease
How does the procedure work?
Carotid endarterectomy in our hospital is usually performed under general anesthesia. After successful anesthesia, an incision will be made in your neck to expose the carotid artery so that it can be blocked and opened. Once the carotid artery is exposed, a plastic tube (carotid diverter) is inserted at each end of the blocked carotid artery to ensure blood flow to the brain while stripping the sclerotic plaque. Once the sclerotic plaque is stripped, the arterial wall is sutured, the diverter tube is withdrawn, the block is released, and hemostasis is performed, usually with a special polyester patch, to avoid future restenosis. Finally, the skin is sutured and a drainage tube is placed in the wound before suturing to facilitate drainage of the residual blood around the artery.
What are the risks of the procedure?
Stroke is the most serious complication after carotid endarterectomy, but the incidence is low, about 1 to 3%. Another uncommon complication is carotid artery reocclusion, which occurs later, usually after 3 months postoperatively, and the incidence of restenosis can be increased in patients who smoke. The incidence of restenosis requiring surgery after carotid endarterectomy is about 2 to 3%. Temporary nerve injury resulting in hoarseness, dysphagia, or numbness of the face or tongue is another uncommon complication that usually returns to normal within 1 month postoperatively without specific treatment. A small amount of wound oozing and skin ecchymosis is normal and usually resolves in the first few weeks after surgery.
What are the conditions that can increase the chance of complications?
A history of stroke will increase the chance of postoperative complications, depending on the severity of the stroke, the time elapsed since the onset of the stroke, and the current degree of recovery. Other factors that may increase the chance of complications include
Presence of severe cardiopulmonary disease
Severe stenosis or occlusion of other arteries supplying the brain, such as the contralateral carotid artery
Restenosis (recurrence) after ipsilateral carotid endarterectomy
diabetes mellitus
Smoking
What should I expect after surgery?
Once you are awake from the anesthesia, you will be taken back to your room and given fluids and medication to keep your blood pressure stable. You may drink water and eat a small amount of liquid food 1 to 2 hours after surgery. There is usually only mild pain after the procedure, but you can ask for pain medication if the pain is unbearable. You may feel discomfort in your throat. You may try to get out of bed the day after the surgery. If there are no special circumstances, we will not give you intravenous fluids. The stitches can be removed 5-7 days after surgery and you can be discharged afterwards.