Carotid Endarterectomy

Why it’s done?

To reduce your risk of having a stroke in the future when:

• Your internal carotid artery is severely narrowed (more than 80%)
• Your internal carotid artery is narrowed by more than 50% and you have experienced symptoms such as stroke, mini-stroke or TIA (transient iscahemic attack).

Description

A carotid endarterectomy may be performed under local or general anaesthetic.

An 8-10cm incision is made along the side of your neck over the carotid artery.

The carotid artery is clamped and opened. The plaque is removed and the artery is repaired by stitching on a synthetic patch. The wound is closed with dissolving sutures and a drain is left in place (usually removed after 24 hours).

The usual hospital length of stay after a carotid endarterectomy is 48 hours.

Risks:

• There is a small risk of stroke associated with carotid endarterectomy.
• 2-3% in patients with no pre-procedure symptoms
• 5% in patients with pre-procedure stroke, mini-stroke or TIA
• Heart attack
• Nerve damage affecting the voice box, tongue or neck

What can I expect after treatment?

Typically you will be discharged home after 48 hours.

You will have a sore throat and the skin around the incision will be numb, this will gradually improve with time.

After an uncomplicated operation you can expect to return to normal activities within 2 weeks of surgery.

You should not drive for 2 weeks after a carotid endarterectomy.

Your carotid arteries will be monitored with regular ultrasounds after your procedure.

Carotid Stenting

Why it’s done?

To reduce your risk of having a stroke in the future when:

• Your internal carotid artery is severely narrowed (more than 80%).
• Your internal carotid artery is narrowed by more than 50% and you have experienced symptoms such as stroke, mini-stroke or TIA (transient iscahemic attack).

Description

Carotid stenting is performed under local anaesthetic.

The femoral artery in groin is accessed under ultrasound and a small plastic sheath is inserted. A wire and catheter inserted through the sheath in the groin are then advanced into the narrowed carotid artery. A fine wire with a special filter attached is then advanced through the narrowed carotid artery. The filter is deployed beyond the narrowing to catch any debris that is released during the stenting procedure. A balloon is used to dilate the narrowed area of the carotid artery and then a stent (a small metal mesh tube) is inserted and deployed. The stent is usually then expanded with a balloon and a final angiogram taken to ensure a satisfactory result has been achieved.

The sheath is removed from the groin and a plug is placed in the femoral artery.

Risks:

• There is a small risk of stroke associated with carotid stenting
• 2-4% in patients with no pre-procedure symptoms
• 6-10% in patients with pre-procedure stroke, mini-stroke or TIA
• Bleeding from the femoral artery access site in the groin

What can I expect after treatment?

You will need to lie flat and rest in bed for several hours after the procedure.

Typically you will be discharged home after 24 hours.

You will be commenced on aspirin and clopidogrel after your carotid stenting procedure.

After an uncomplicated procedure you can expect to return to normal activities within 48 hours.

You should not drive for 2 weeks after a carotid stenting.

Your carotid arteries will be monitored with regular ultrasounds after your procedure.