Carotid Endarterectomy Surgery in Delhi, India

A carotid endarterectomy is a surgical procedure performed to remove plaque buildup from the carotid arteries, the main blood vessels that supply blood to the brain. This procedure is crucial in preventing strokes caused by carotid artery disease. The goal of carotid endarterectomy is to restore normal blood flow to the brain, reducing the risk of stroke and other complications associated with carotid artery blockage.

Who Needs to Have a Carotid Endarterectomy?

Carotid endarterectomy is usually recommended for individuals with significant carotid artery stenosis. This condition involves a narrowing of the carotid arteries due to plaque buildup. Patients who have experienced transient ischemic attacks (TIAs) or minor strokes and have a substantial blockage (usually more than 50%) in their carotid arteries are candidates for this procedure. It is also recommended for patients with severe carotid artery blockage (70% or more), even if they have not had symptoms.

Why is a Carotid Endarterectomy Done?

Carotid endarterectomy is done to prevent strokes. When plaque builds up in the carotid arteries, it can restrict blood flow to the brain or cause blood clots to form, leading to a stroke. By removing this plaque, the procedure reduces the risk of stroke and improves blood flow. It is especially beneficial for patients who have already experienced symptoms of carotid artery disease, such as TIAs or minor strokes, as it helps prevent further cerebrovascular events.

What Happens Before a Carotid Endarterectomy?

Before a carotid endarterectomy, a thorough evaluation is conducted to determine the extent of carotid artery blockage and the patient’s overall health. This evaluation includes:

• Imaging tests: Ultrasound, CT angiography, or MR angiography to assess the severity of the blockage.
• Medical history and physical examination: The patient’s medical history and physical exam are reviewed to ensure they are suitable candidates for surgery.
• Medications: The doctor may advise on specific medications to take or avoid before surgery.

What Happens During Carotid Endarterectomy?

During the carotid endarterectomy procedure:

• Anaesthesia: The patient is given general anaesthesia or local anaesthesia with sedation.
• Incision: A small incision is made on the side of the neck where the blocked carotid artery is located.
• Clamping: The carotid artery is temporarily clamped to stop blood flow.
• Plaque removal: The surgeon opens the artery and removes the plaque buildup.
• Repair: The artery is then repaired with stitches or a patch to prevent narrowing.
• Closure: The incision is closed with sutures, and the patient is moved to the recovery area.

The entire procedure usually takes about two hours.

What Happens After a Carotid Endarterectomy?

After the surgery, patients are monitored in a recovery area or intensive care unit for a day or two. Key aspects of post-operative care include:

• Monitoring: Vital signs and neurological status are closely monitored.
• Medications: Antiplatelet or anticoagulant medications may be prescribed to prevent blood clots.
• Follow-up: Regular follow-up visits are scheduled to monitor the patient’s recovery and assess the procedure's success.
• Activity: Patients are advised to avoid strenuous activities for a few weeks and gradually resume normal activities as per the doctor’s advice.

Advantages of Carotid Endarterectomy

Carotid endarterectomy offers several advantages, including:

• Stroke prevention: Significantly reduces the risk of stroke in patients with carotid artery disease.
• Improved blood flow: Restores normal blood flow to the brain, reducing the risk of cerebrovascular events.
• Symptom relief: Alleviates symptoms associated with carotid artery disease, such as TIAs and minor strokes.
• Long-term benefits: Provides lasting benefits by removing the plaque and preventing future blockages.

Risks or Complications of Carotid Endarterectomy

While carotid endarterectomy is generally safe, it does carry some risks and potential complications, including:

• Stroke: Although rare, there is a risk of stroke during or after the procedure.
• Heart attack: The stress of surgery can sometimes trigger a heart attack.
• Nerve damage: There is a risk of nerve damage that can affect swallowing, speech, or shoulder movement.
• Bleeding: Post-operative bleeding is a potential complication.
• Infection: As with any surgery, there is a risk of infection at the incision site.
• Re-narrowing: The artery may narrow again over time, requiring further treatment.

When To Call the Doctor?

Patients should contact their doctor immediately if they experience any of the following after carotid endarterectomy:

• Severe headache or dizziness.
• Weakness or numbness in the face, arm, or leg.
• Difficulty speaking or understanding speech.
• Vision problems in one or both eyes.
• Swelling or redness at the incision site.
• Signs of infection, such as fever or chills.

The outcome after carotid endarterectomy is generally positive, with most patients experiencing a significant reduction in stroke risk and improved blood flow to the brain. The success rate of the procedure is high, and many patients return to their normal activities within a few weeks. Regular follow-up visits are essential to monitor the patient’s recovery and ensure the long-term success of the surgery.

Frequently Asked Questions

Is carotid endarterectomy a high-risk surgery?

Carotid endarterectomy is considered a relatively low-risk surgery, especially in the hands of an experienced surgeon. However, as with any surgery, there are risks involved, including stroke and heart attack.

Which is safer, a carotid endarterectomy or a stent?

Both carotid endarterectomy and carotid stenting are safe and effective. The choice between them depends on individual patient factors and the severity of the artery blockage.

How painful is a carotid endarterectomy?

Most patients experience mild to moderate pain after the surgery, which can be managed with pain medications.

What is the success rate of a carotid endarterectomy?

The success rate of carotid endarterectomy is high. It significantly reduces stroke risk and improves blood flow to the brain.

What nerve is damaged in a carotid endarterectomy?

The hypoglossal nerve, which controls tongue movement, is the most commonly affected nerve, though nerve damage is rare.

What is the life expectancy after a carotid endarterectomy?

Life expectancy after carotid endarterectomy is generally good, with many patients experiencing long-term benefits and a reduced risk of stroke. Regular follow-up and healthy lifestyle choices can further enhance outcomes.

Review

Reviewed by Dr. Kapil Gupta - Associate Director - Vascular and Endovascular Surgery on 9 Aug 2024.