Carotid endarterectomy - the operation
In addition to surgery, all risk factors have to be addressed. This means giving up smoking, controlling your blood pressure (reducing this by 5 mm of mercury lowers the risk of stroke by 35%), controlling your cholesterol levels and starting on aspirin (reduces long-term risk of stroke by 25%). See 'Lifestyle measures to tackle atherosclerosis'.
Endarterectomy refers to the removal of atheroma from inside the artery and then closing the artery - usually with a patch to keep it wide open and reduce the chances of subsequent narrowing.
I prefer to carry out the operation under a general anaesthetic (with the patient asleep) although some surgeons perform it under local anaesthetic (with the patient awake).
An incision is made in the neck and the arteries exposed. To do this some branches of the jugular vein have to be tied. Various nerves (see anatomy) are encountered during the dissection and these have to be preserved.
Once the arteries are dissected, heparin is given into an arm vein to thin the blood before clamps are applied to the vessels to create a bloodless operating field. The atheroma is removed with care being taken to remove all loose pieces of debris.
This photograph shows a typical atheroma specimen removed from an artery. The 2 wires indicate where the blood would have flowed through the internal and external carotid arteries. |
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The hole in the artery is then closed with a patch - I use either vein taken from the arm or a polyester ('dacron') patch ready-made for the purpose.
| This photograph shows a vein patch used to close the hole in the carotid artery. It is stitched into place with a permanent stitch. |
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Once any bleeding has been stopped, the wounds are closed. Sometimes a drain (small tube) is left deep in the wound next to the arteries. This is to allow the drainage of any blood that may accumulate.
The whole operation takes about 90 minutes.
If you wish to see a video of the operation, click here. The video may take a few minutes to load.
You may have heard of treating a narrowing in the blood vessel by stretching it open with a balloon. This is angioplasty. It is being applied to the carotid arteries but at present remains an experimental tool. It is undergoing trials comparing it to the standard operation. Until the results of these are available, it cannot be recommended as main stream treatment.
