Carotid Endarterectomy

Carotid endarterectomy is a surgical procedure used in patients with stenosis (narrowing) of the common or internal carotid artery by an atherosclerotic plaque.

The essence of the procedure is the removal of cholesterol deposits (plaque) from the artery lumen with the restoration of normal blood supply to the brain, and as a result, the prevention of such a dangerous complication as ischemic stroke.

Through numerous studies, it has been proven that stenosis of the internal carotid artery by more than 70% increases the risk of developing ischemic stroke by 5 times, leading to changes in local blood flow parameters with microthrombosis and trauma to the vessel wall. Patients requiring this operation are often troubled by dizziness, instability when walking, ringing in the ears or head, visual disturbances ('veil', 'cobweb', 'floaters' before the eyes), sudden weakness in the arm/leg.

Indications for carotid endarterectomy are determined by a vascular surgeon based on symptoms, duplex ultrasound (US) data, and computed tomography of the brachiocephalic segment (neck section). There are cases when there are no precursors of the disease, and significant stenosis of the carotid artery is an incidental finding during examination. It is worth sounding the alarm when carotid artery stenosis is 50%, and starting from 70%, the surgeon is more likely to recommend surgical treatment.

Now, let's delve into the technique of performing the carotid endarterectomy procedure. Together with the anesthesiologist, the type of anesthesia is determined, local (conductor) or general.

• In the first option, the patient remains conscious throughout the operation, maintaining speech and visual contact.
• In the second case, you will be put under general anesthesia, and awakening will only occur after the operation is completed. The traditional approach is through the anterolateral surface of the neck - a linear incision of 4-6 cm in length is made. The surgeon uses professional optics with magnification, and with the help of special instruments, the arteries are separated from surrounding structures (nerves, veins). The common, external, and internal carotid arteries are identified with subsequent application of vascular clamps. The common carotid artery is intersected just below the bifurcation. All freely lying remnants of the plaque in the vessel lumen and the outer layer of the artery are carefully removed, and the outer layer of the artery is returned to its original position. Then, the artery is sutured with a continuous suture with subsequent tensioning (everting), or with a patch from xenopericardium, the final choice of surgical tactics is possible only during the operation. Clamps are removed, after which blood flow in the clamped arteries is restored. Only after careful checking of the sutures for tightness and absence of sources of bleeding, layered suturing of the wound with a cosmetic suture is performed. The duration of carotid artery endarterectomy on average takes about 1-1.5 hours, and in the postoperative period, long-term observation and treatment in the intensive care unit is usually not required.

In the High Medical Technologies Clinic, a clear standard has been developed, which allows patients to be discharged the day after the operation, which has a favorable effect on early rehabilitation and prevents the occurrence of infectious complications. The attending physician will discharge you home with recommendations, strict adherence to which will help avoid further complications and the appearance of new atherosclerotic plaques on the walls of vessels supplying the brain.