Carotid Artery Disease and Treatment
Carotid artery disease is where there is an accumulation of plaque within one of the main arteries that supplies the brain. In some situations we would consider removing this surgically to prevent stroke or mini stroke (transient ischaemic attack/TIA)
How does it occur?
Atherosclerosis is a condition where plaque accumulates in the wall of an artery. Atherosclerosis can generally occur in almost any artery, but is more prone in areas where arteries divide due to additional stress that is placed on the wall of an artery due to variations in blood flow at these points.
Atherosclerosis is a complex and evolving area of knowledge in understanding, but is thought to occur due to a variety of factors. These include poor diet, smoking, family history and dyslipidaemia and hypercholesterolaemia.
Treatment for carotid artery disease ranges from medical therapy (medications) and surgery – which could be a surgical clean out of the carotid bifurcation or in some situations carotid stenting. We consider treatment for carotid disease if there is recent evidence of stroke or mini stroke if a patient is fit enough for surgery. In some less frequent situations we may consider prophylactic clean out of the carotid artery if there is a high degree of narrowing in younger patients.
How is the surgery performed (carotid endarterectomy)?
An incision is made along the neck in front of one of the main muscles involved in neck movement. Beneath this muscle the artery is found surrounded by a layer of tissue and usually covered by the internal jugular vein. The artery is released from the surrounding tissue prior to commencing removal of plaque. At this stage, strong blood thinners are given and the artery is clamped prior to being opened. At this stage a temporary shunt is placed to keep blood going to brain and the plaque is removed. A patch is placed on the artery, usually made of bovine pericardium to prevent scar tissue forming that could significantly re-narrow the blood vessel.
Risks associated with surgery:
- Stroke (2%)
- Nerve injury
- Recurrent disease
- Death and heart attack following surgery are extremely rate but have been reported.
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