Carotid Artery Interventions

The carotid arteries are the large blood vessels in the neck that carry blood to the brain. If the flow of blood through the carotid arteries is blocked suddenly, the result is a stroke. Carotid artery interventions are types of surgery that ensure that blood is able to freely flow to the brain.

When fat, cholesterol, calcium, and other substances in the blood start to build up along the inside wall of arteries, it’s called plaque. If enough plaque builds up in the carotid artery, the risk of a stroke increases. One of the most common causes of strokes is when a piece of plaque breaks off of the wall and travels to the brain. To minimize the risk of stroke (or to reduce the risk of another stroke in patients who have already had one), heart doctors often perform one of two types of surgery: a carotid artery surgery (or endarterectomy) or a carotid stenting.

Endarterectomy

In this type of surgery, doctors expose the carotid artery in the neck. They insert a piece of tubing, called a shunt, into the carotid artery. When the carotid artery is surgically cut open, the shunt acts as a detour, allowing the blood to flow around the opened artery to the brain. With the shunt in place, the doctor can remove the plaque from the walls of the artery. Once the surgery is complete, the shunt is removed. By cleaning out the plaque, the doctor reduces the chance of future strokes.

During a carotid endarterectomy, you will have anesthesia so you won’t feel much pain. In some cases, this will be a local anesthetic, so that you can talk to the doctor, and he can ensure that your brain is getting sufficient blood. In other cases, you may get a general anesthetic (so you will not be awake during the surgery). The surgery usually takes about two hours. After the surgery, you may stay in the hospital for one to two days to allow you to safely recover from the surgery. If your surgery is performed early in the day, and you are recovering well, you may be allowed to go home the same day.

Carotid angioplasty and stenting

This form of surgery ensures that the plaque stays in place and does not break loose since the plaque is not removed. A small cut is made in the groin area of the femoral artery. A small, flexible tube called a catheter is inserted into the cut and is carefully navigated up through the blood system to the blocked carotid artery. This will serve as a tunnel to deliver the other devices up to the site of the artery blockage.

Using a guide wire, a tiny, empty balloon is inserted into the catheter and pushed to the carotid artery. Once the balloon is at the site of the blockage, it is inflated and packs the plaque against the artery wall, widening the artery and restoring the blood flow. (Packing the plaque with a balloon in this way is called angioplasty.) The balloon is removed, and a small, metal-mesh tube called a stent is moved to the artery via the catheter. Once in place, the stent automatically expands. It pushes against the plaque and holds the plaque in place. To further open and position the stent, a second balloon is placed into the center of the stent and inflated. This completes the surgery, and the surgeon removes the balloon and catheter. The stent remains in place.

Before and after carotid angioplasty and stenting, you may be required to change your medications, particularly to help reduce the risk of blood clots. Before the operation, you will be given medicine to help you relax and a local anesthetic in your groin, where the surgeon will insert the catheter. You’ll lie on your back and remain awake during the procedure so you can follow the surgeon’s instructions. You may feel some pain when the balloon is inflated to push the stent in place. The procedure usually lasts about an hour.

Possible side effects for either procedure can include allergic reactions to some of the medicines and dyes used during the procedure, and some people experience irregular heartbeats. As with all surgeries, bleeding and infection are risks. Other risks include blood clots or bleeding in the brain near the site of surgery, brain damage, heart attack, strokes, or more blockage of the artery over time.

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