Everyone knows that stroke is considered one of the common causes of death among the population of the entire planet. This disease occurs with the same frequency in all countries of the world. Often a violation of cerebral circulation leads to paralysis and paresis, causing temporary or permanent disability. To avoid the development of this disease, it is necessary to diagnose the provoking factors of stroke in time and deal with them. The main cause of stroke is atherosclerosis of the arteries of the neck and head. Vascular blockage in the elderly and senile age is observed in almost all. Most people over 60 years of age carry out drug prophylaxis of atherosclerosis. In some cases, drug treatment no longer has the desired effect. Then surgery is indicated - carotid endarterectomy. This procedure involves removing a portion of the vessel damaged by atherosclerosis.
Why Carotid Endarterectomy?
The blood supply to the brain depends on the condition of the carotid arteries. These vessels are branches of the aorta. They are located symmetrically on both sides in the neck. Entering the cranial cavity, carotid arteries are divided into smaller brain branches. Patients suffering from atherosclerosis have a high risk of blood clots in these vessels. They consist of cholesterol plaques and fibrous tissue. With an increase in blood pressure, blood clots in the carotid arteries can break away from the vessel wall and enter the brain. As a result, they cause ischemia - insufficient oxygen supply to the tissues. Such a violation of cerebral circulation leads to dire consequences. To prevent a stroke, a carotid endarterectomy is performed. It helps prevent ONMK and its consequences.
Description of procedure
Carotid endarterectomy is an surgical intervention, which consists in cleaning the inner layer of the vessel from atherosclerotic plaque. It is performed in cases where drug treatment is powerless or the risk of developing stroke is too high. Medications are not able to provide the desired effect when an atherosclerotic plaque occupies more than half the diameter of the carotid artery. Or if cholesterol closes the lumen of the vessel from several sides simultaneously. In addition, the risk of stroke increases significantly in the presence of uncontrolled hypertension. In this case, the atherosclerotic plaque can at any time tear itself away from the endothelium, regardless of its size. The result may be a blockage not of the carotid artery itself, but of its branches that feed the brain. As a result, an ischemic stroke develops.
Indications for carotid endarterectomy
The operation (carotid endarterectomy) is not performed for everyone. For a doctor to give permission for surgical intervention, there must be serious evidence. Often the operation is done to patients who already have a history of cerebrovascular accident. So, in what cases is carotid endarterectomy justified? Indications for the following:
- The diameter of the vessel is closed by atherosclerotic plaques more than half.
- History of repeated strokes.
- The combination of hypertension (in the stage of compensation) and atherosclerosis of the carotid arteries.
Contraindications for surgery
Despite the benefits of surgery, in some cases they can not be performed. Like other operations, a carotid endarterectomy also has contraindications. The reviews of patients suffering from atherosclerosis make it clear that many different examinations are performed before surgery. Only after the doctor is convinced of the absence of contraindications, the patient begins to prepare for surgery. Carotid endarterectomy is prohibited in the following cases:
- Uncontrolled medication (decompensated) hypertension.
- Extensive acute cerebrovascular accident.
- Unstable angina pectoris or recent myocardial infarction.
- Acute heart failure.
- Recently suffered a stroke.
- Chronic circulatory failure 2 and 3 degrees.
- Alzheimer's disease.
- Oncological diseases of a severe degree.
Carotid Endarterectomy Preparation
Before making a carotid endarterectomy, various examinations are necessary. First of all, a duplex ultrasound of the vessels of the head and neck is shown. Thanks to this method, the doctor can judge the degree of closure of the lumen of the arteries with atherosclerotic plaques. In some cases, angiography of the vessels is necessary. This study consists in the introduction of a contrast medium into the blood, followed by x-ray control. A more accurate method is CT angiography. It allows you to evaluate the shape, size and localization of cholesterol overlays on the endothelium. If the doctor suspects ischemia of certain parts of the brain, magnetic resonance imaging is performed. When the doctor has identified indications for surgery, he needs to make a conclusion about the general condition of the patient. To do this, before carotid endarterectomy, an ECG, OAK are done, a blood chemistry test and a coagulogram are taken. If the patient has other pathologies, then consultation of specialists (endocrinologist, cardiologist) is necessary.
Stages of Carotid Endarterectomy
The first step in the operation is anesthesia. The choice of anesthesia depends on the opinion of the doctor, as well as on the desire of the patient. Local anesthesia or general anesthesia may be performed. After this, the surgeon makes an incision in the area where, according to the results of ultrasound or angiography, there is a cholesterol plaque. The next step is the clamping of the vessel. Next, the incision is made on the carotid artery itself. After the doctor visually assesses the size and extent of the atherosclerotic plaque, he concludes on how to continue the operation. There are several techniques. Most often resort to open endarterectomy. By this is meant a longitudinal dissection of the vessel and “scraping” of cholesterol deposits. After that, a patch is placed on the site of the damaged endothelium. Another method is eversion endarterectomy. For this, the vessel is turned inside out and is cleansed of atherosclerotic masses. If the damage to the carotid artery is large, it is replaced in a certain area. For this, synthetic fabrics are used. The final stage of carotid endarterectomy is layering.
How is the postoperative period?
After carotid endarterectomy, it takes time to restore blood flow. It takes several weeks. Since the incision in the neck area is small, pain is not very pronounced. However, analgesics may be required on the first day. Also, you can not lift heavy objects and perform physical exercises for several weeks from the moment the carotid endarterectomy was performed. The postoperative period proceeds well if all the doctor’s prescriptions are followed, not only while in the hospital, but also when the patient is discharged. Sutures are removed on the 7-10th day from the moment of surgery.
Complications of carotid endarterectomy
It should be remembered that any surgical intervention entails risks. Carotid endarterectomy is no exception. Complications after this operation are rare, in about 3% of cases. Nevertheless, they occur, and the patient should be warned about this.
The very first complication of the postoperative period is the failure of the sutures. In this operation, the penetration of bacteria into the wound is very dangerous for the patient's life, since the incision is made directly on the vascular bed. This complication may occur due to non-compliance with the rules of antiseptics.
Another dangerous condition associated with carotid endarterectomy is stroke. Acute cerebrovascular accident may occur as a result of detachment of a fragment of an atherosclerotic plaque during surgery and its entry into the vessels of the head. This complication is quite rare, in 2-3% of cases.
In addition, after the operation, temporary disorders of voice and swallowing are sometimes observed. This is due to damage to the nerve endings located in the neck.
Restenosis is considered a later complication of carotid endarterectomy. By this is meant a repeated narrowing of the lumen of the vessel. Most often, restenosis is observed in patients who do not comply with the doctor's prescription.
Prevention of postoperative complications
Complications such as stroke and damage to the nerve endings of the neck are independent of the patient, as they arise during surgery. Nevertheless, the prevention of other conditions is possible only thanks to the combined work of the doctor and patient. This is especially true for the reappearance of atherosclerotic plaques. After the operation is left behind, the patient must be constantly monitored by a specialist. In addition to conducting diagnostic procedures, the doctor gives the patient useful recommendations. First of all, this concerns the lifestyle: the patient needs to give up smoking and alcohol, follow a diet (eat low-fat foods). Also, for the prevention of restenosis, medication is prescribed. The patient should take lipid-lowering drugs every day (Atorvastatin drug), antiplatelet agents (Cardiomagnyl, Clopidogrel tablets).
Operation "carotid endarterectomy": pros and cons
Like all surgical procedures, this operation has both advantages and disadvantages. Some doctors do not recommend carotid endarterectomy until atherosclerosis can be treated conservatively and the patient has no clinical manifestations of the pathology. Other doctors believe that surgery is necessary with a significant narrowing of the lumen of the artery, regardless of whether the patient has symptoms or not. The advantage of this procedure is the complete cleansing of the vessel of cholesterol, improved blood flow. The operation can significantly reduce the risk of stroke. However, endarterectomy does not guarantee that the vessel will not be damaged again. Also during the operation, complications may develop in the form of nerve damage or stroke. Most doctors attribute this manipulation to relatively harmless procedures, and its results are considered significant.
Carotid endarterectomy: reviews of operated people
Positive and negative opinions are found when discussing any surgical treatment. Carotid endarterectomy is no exception. Reviews of operated people are various. In most cases, people are happy with the operation. Thanks to it, symptoms of ischemia pass (impaired attention, memory, sleep), examination results and general condition improve. Some patients noted a change in voice, a violation of swallowing after endarterectomy. In most cases, these symptoms lasted about a month, after which they completely disappeared.