We all fear the word "stroke," don't we? It's the worst thing that can happen when the blood flow to the brain suddenly stops. Many people think that this only happens because of a heart problem. But did you know that a blockage in a major blood vessel in your neck can also be a major cause of a stroke? Today, we're going to talk about a special surgery that clears such a blockage and restores blood flow to the brain.
Simply put, what is Carotid Endarterectomy?
Imagine that two major arteries that supply blood to your brain run up your neck on either side. These blood vessels are called the "Carotid Arteries." Over time, things like unwanted fat and cholesterol from the foods we eat start to build up on the walls of these blood vessels. It's like dirt building up inside a water pipe. We call this plaque .
As this plaque grows larger, it begins to block the blood vessel from the inside. This reduces the amount of blood flowing to the brain. Sometimes, a small piece of this plaque can break off and completely block a small blood vessel in the brain. That's when a stroke occurs.
So, a carotid endarterectomy is a surgical procedure that opens up the blocked carotid artery, removes the plaque that's stuck inside, and then cleans and stitches the blood vessel back together. Simply put, it's about cleaning the blood flow. This can greatly reduce the risk of a stroke.
In what cases is this surgery recommended?
Your doctor will not recommend this surgery right away. He or she will make a decision based on your examination, the necessary tests, and the results. This surgery may usually be recommended for someone with the following conditions:
| Condition | Simple explanation |
|---|---|
| A significant level of blockage | If a scan (ultrasound) confirms that your carotid artery is more than 50% blocked by plaque. |
| Having a mini-stroke (TIA) | If you have previously had a Transient Ischemic Attack (TIA) , which is a small warning sign that precedes a major stroke (such as slurred speech for a few minutes, loss of sensation on one side of the body). |
| Having a mild stroke | If you have already had a mini-stroke due to a blockage in this artery. |
| Severe blockage without symptoms | To prevent a future stroke, even if you have no symptoms, if a scan shows that the artery is severely blocked. |
How do you prepare before surgery?
Your medical team will give you instructions before this surgery. These may include:
- Special tests: You may be asked to do special scans such as a `(Cerebral Angiogram)`, `(CT Angiography)` or `(MR Angiography)` to learn more about the condition of your carotid arteries and brain.
- Tell your doctor about all the medications you take: You need to tell your doctor about everything, not just prescription medications, but also painkillers, vitamins, and traditional medicines.
- Stopping certain medications: Some medications that prevent blood clotting are advised to be stopped a few days before surgery. However, in most cases, medications like aspirin are advised to be continued. Get specific advice about this.
- Quitting smoking: If you are a smoker, you should definitely quit before surgery. It will help you heal faster.
How the surgery is performed
This surgery is done in a hospital. It usually takes about an hour or two. You may be given general anesthesia (put to sleep) or local anesthesia (numbing only the area around your neck). You will be given medication to help you relax, even if you are numb.
The surgeon follows these steps:
1. A small incision of about 4 inches is made in the neck, where the blood vessel is blocked.
2. Since bleeding into the brain cannot be stopped during surgery, if necessary, a small tube (shunt) is inserted to temporarily divert the blood.
3. Then, a small incision is made along the blocked blood vessel and the plaque layer inside is carefully cleaned and removed.
4. The blood vessel is then sewn back together. Often, a special "patch" is sewn in place to keep the area wide and not constricted again.
5. Finally, the temporary tube is removed and blood flow is restored to normal.
Most importantly, the main goal of this surgery is to reduce the risk of stroke. When performed by an experienced medical team, this is a very successful surgery.
What are the benefits and risks?
Like any surgery, there are some risks involved, but the benefits outweigh the risks in most cases.
Main benefit: Protection from a severe stroke in the future.
Possible risks:
- Bleeding
- Infectious conditions
- Blood clots
- Nerve damage (rare)
- Having a stroke or heart attack (very rare)
- Re-blockage of the artery in the future
This risk can vary from person to person. It depends on factors such as your age, whether you have other medical conditions such as diabetes or heart disease, and the extent of the blockage in your blood vessel. Your doctor will explain all of this to you.
After surgery and recovery period
After the surgery, you will be kept in the hospital for about a day for observation. After a few hours, you will be able to eat and drink normally. A small tube (drain) may be placed in your neck to drain fluid from the wound. This is usually removed within a day. You may have some neck pain for about two weeks. You can take regular painkillers for this.
Most people can go home the day after surgery. You can shower after you go home, but don't rub the wound too hard. You can return to normal activities in a week or two.
Lifestyle changes are very important!
Even if the surgery is successful, you will still need to change your lifestyle to prevent this type of plaque from forming again.
- Get used to a healthy diet.
- Exercise as directed by your doctor.
- Quit smoking completely.
- Reduce stress.
- Take your cholesterol and blood pressure medications exactly as prescribed.
If you have these symptoms, call your doctor immediately.
If you experience any of the following symptoms after your surgery, notify your doctor immediately or go to the hospital's Emergency Department (ETU).
| Feature to pay attention to | Description |
|---|---|
| Wound-related problems | The wound is red, swollen, and oozing yellow or green fluid. |
| Symptoms of a stroke | Sudden headache, difficulty speaking or understanding, dizziness, numbness on one side of the body, vision problems. These are very serious emergencies. |
| Common infection symptoms | Fever, chills and shivering. |
| Other serious symptoms | Difficulty breathing, chest pain, swelling of the legs, difficulty swallowing. |
Take-Home Message
- Carotid Endarterectomy is a very important surgery performed to prevent future strokes caused by fatty deposits blocking a major blood vessel in the neck.
- This is not something that is done for everyone. It is only recommended if absolutely necessary, after tests performed by your doctor.
- In order for the surgery to be successful, it is essential to change your lifestyle to a healthy one to prevent this condition from recurring.
- Be aware of the potential danger signs that may arise after surgery. If you have any concerns, seek medical advice immediately.
- If you have any questions about this, don't be afraid to talk to your doctor and resolve them.
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