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Neurology, Ophthalmology, Cardiology, Oncology, Obesity, Endocrinology, Vascular surgery - Causes, Symptoms, Diagnosis, Treatment, description of the disease.

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Saturday, 08.08.2020, 06:54
Main » Vascular surgery » Carotid endarterectomy 
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Carotid endarterectomy


Removal of the inner wall of the carotid artery


Carotid endarterectomy - a surgical intervention to remove the inner wall of the carotid artery that is affected by the atherosclerotic plaque narrowing the artery and destruction. The operation resulted in a restoration of blood flow in the carotid artery.

With age, the inner wall of arteries, atherosclerotic plaques are formed. These plaques are composed of cholesterol, calcium and fibrous tissue. The greater the atherosclerotic plaque is formed on the inner wall of the arteries, the greater the narrowing of the lumen and the stronger the disturbance of blood flow. This pathological process is called atherosclerosis. In the end, narrowing of the arteries leads to disruption of cerebral circulation.

Carotid artery away from the aortic arch. They are on both sides of the neck to the skull, which further break down into the arteries that feed blood to the brain.

The disease is a serious carotid artery disease. With increased pressure can break away from the plaque of the arteries. They are carried away by the blood stream and clog the blood vessels of the brain, thus disrupting the blood supply to certain areas of the brain. At the same time developing an ischemic stroke. If the plaques violate the blood flow in small arteries, this process is called a transient ischemic attack, or microstroke. Transient ischemic attacks are often terrible signal to the fact that the patient has a high risk of stroke and treatment is required.

One method of treatment in this case is the operation of carotid endarterectomy. It is relatively safe, and has a lasting effect.

Before the operation, usually carried out special investigations:

  • Duplex ultrasound scanning
  • Computed tomography of the head
  • Angiography


These research methods can help determine the level and degree of impairment of blood flow in the vessels of the neck and head, blood flow, the presence of plaques and some other parameters of cerebral circulation.
Indications for carotid endarterectomy surgery

This surgery is indicated for patients with severe narrowing of the lumen of the carotid arteries, particularly suffered transient ischemic attacks, have a satisfactory general condition. Relative contraindications include:

  • a massive stroke
  • common tumor
  • high blood pressure
  • unstable angina
  • myocardial infarction in the last 6 months
  • congestive heart failure
  • signs of progressive brain disease such as Alzheimer's disease


What is the risk of complications in carotid endarterectomy?


The presence of a stroke increases the risk of complications, depending on the severity of stroke, prevalence and consequences. Moreover, the risk of complications increases with the following conditions:

  • severe concomitant diseases of the heart or lungs
  • presence of atheromatous plaques in remote places of the arteries
  • extensive blockage of the other carotid artery
  • recurrence of blockage or narrowing of the lumen of the vessel after carotid
  • endarterectomy
  • diabetes mellitus
  • smoking


The method of operation of carotid endarterectomy


The operation is performed either under general or local anesthesia. Preferable to local anesthesia due to significantly fewer complications, a shorter period of rehabilitation, as well as taking into account the point that being in mind you can help the surgeon to monitor the status of cerebral blood flow.

 Before the surgery done shaving the neck to prevent infectious complications. After anesthesia, the surgeon makes a small incision along one side of the neck. Provided the carotid artery. The surgeon grasps her to stop blood flow through it. At this time, the brain receives blood from the carotid artery on the other side. Alternatively, at the time of surgery, the surgeon can install a shunt to bypass the affected area of the carotid artery to the blood supply to the brain.

After separation and compression of the carotid artery, the surgeon makes a cut just above the point of narrowing. After this, the surgeon cleans like atheromatous plaques are available by scraping the inner wall of the carotid artery. Next, an incision in the artery is sutured and blood flow is restored. Sometimes, in order to expand the lumen of the artery it installed a small "patch" that can be done either from the patient's own veins, taken from the lower extremity, or of synthetic material. After that, the wound in the neck sutured. Sterile dressing is applied. The duration of the operation is about 2 hours.

Postoperative period after carotid endarterectomy


Typically, the patient remains in hospital after surgery for 1-2 days. This is necessary so that the surgeon can monitor the status of cerebral circulation after surgery. Usually the patient after the operation receives intravenous fluids through a special catheter. Given that the post-operative wound in the neck is small, slight pain states. Sutures are removed on the seventh day after surgery. After discharge from the hospital the patient is recommended for a few weeks to avoid heavy physical exertion.

Possible postoperative complications of carotid endarterectomy


As with any surgical procedure after carotid endarterectomy are possible complications. the most serious of them - it's a stroke. The risk of developing it is 1 - 3%. In addition to stroke, a complication occurs as a re-blockage of the carotid artery, called restenosis. It is most common in those patients who have not given up smoking. The risk of restenosis is 2-3%.

Another complication is nerve damage that leads to the breakdown of votes (hoarseness), difficulty swallowing, numbness of the face or tongue. Typically, these complications do not require special treatment and resolved on their own in a month. However, the risk of these complications is much less than the risk of stroke if carotid endarterectomy surgery was not performed adequately.

Prevention of cerebrovascular


In the initial stages of the disease can recommend lifestyle changes that include diet (restriction of cholesterol and fats), exercise, in addition, it is recommended that all persons older than 45 years of aspirin use, as a means of lowering blood clotting and thrombus formation warning in the lumen blood vessels. It is also necessary in the presence of concomitant diseases such as diabetes and hypertension compliance with proper and regular treatment. An obligatory condition for preventing recurrent ischemic attacks is not smoking.

Patients who had undergone carotid endarterectomy surgery is recommended aspirin, a drug that thins the blood and prevents blood clots in the arteries and reduces the risk of recurrent cerebral circulatory disorders.



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