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Carotid stenosis

The carotid arteries supply blood flow to the brain. Plaque buildup in these arteries can cause stroke. Plaque is caused by atherosclerosis, or "hardening of the arteries." For more on atherosclerosis risk factors, click here. 

If you have risk factors for atherosclerosis, or if you have suffered a stroke or mini stroke, or if your doctor hears a bruit (high pitched sound) on the side of your neck with a stethescope, he or she may order an ultrasound to evaluate your carotid arteries. The ultrasound will tell if you have a narrowing (stenosis) in the artery caused by atherosclerosis.

Stroke is the leading cause for disability in the United States. More than 1/2 of all strokes are caused by carotid disease. Typically, this occurs because pieces of the plaque or blood clot forming on the plaque surface breaks loose and travels downstream to block small arteries in the brain; we call these emboli. Symptoms of stroke or mini stroke include weakness or numbness on one side of the body, garbled or non-sensical speech or inability to speak, facial droop, sudden loss of vision in an eye, dizziness and balance issues.

We recommend treating severe carotid stenosis to reduce risk of stroke. People who have suffered stroke or mini stroke may also benefit from surgery in order to prevent future strokes. 

Carotid endarterectomy

 

Carotid endarterectomy remains the gold standard for treatment of carotid disease. It is an operation that has been performed for over 60 years and has a proven track record of long term success in reducing risk of stroke in appropriately selected patients.

This surgery typically takes 1 to 2 hrs and is performed under a light general anesthetic. The artery is identified through a small (5-7cm) incision along the side of the neck. It does not sit deep to the skin surface; the muscle is shifted to the side to expose it. The artery is then clamped temporarily and opened longitudinally. Sometimes a temporary silastic tube (shunt) is used to divert blood flow to the brain around the part of the artery we are working on. The plaque is removed by scraping the inner lining of the artery with a small spatula. The artery is reclosed by sewing a small Dacron patch into the open edges of the artery, so that the artery is larger than it was before. The patch decreases the chance of recurrent narrowing to less than 5% in your lifetime.

Patients typically stay overnight in the hospital and are discharged the following morning. Sometimes blood pressure medications are held or adjusted temporarily after surgery because it is not atypical for the blood pressure to be transiently lower than usual after carotid surgery. It is common to have a sore throat or hoarseness for a few days after surgery because of the breathing tube. We ask you to keep your head elevated at nighttime on 2-3 pillows and not to drive or do heavy lifting or swimming for the initial 2 weeks after surgery, but otherwise, there are not activity restrictions. It is common to have numbness around the incision after surgery; the area involved will decrease over time. 

Risks of this procedure include heart and lung issues, nerve injury (less than 1%), stroke or mini-stroke (1-3% nationally). Bleeding issues and infection are rare (<5%).

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