Everyone knows that stroke is considered one of the most 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. Blockage of blood vessels in the elderly and senile age is observed in almost everyone. Most people older than 60 years of age carry out medical prophylaxis of atherosclerosis. In some cases, drug treatment no longer has the desired effect. Then surgery is indicated - carotid endarterectomy. This procedure consists in removing a section of a vessel damaged by atherosclerosis.
Why Carotid Endarterectomy?
The blood supply to the brain depends on the state of sleeparteries. These vessels are branches of the aorta. They are located symmetrically on both sides in the neck area. Entering the cranial cavity, the carotid arteries are divided into smaller cerebral branches. Patients suffering from atherosclerosis are at 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 stroke and its consequences.
Procedure description
Carotid endarterectomy is a surgical intervention that consists in cleansing the inner layer of the vessel from atherosclerotic plaque. It is performed in cases where medical treatment is powerless or the risk of developing stroke is too high. Medicines are not able to have 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 at the same time. In addition, the risk of stroke is significantly increased in the presence of uncontrolled arterial hypertension. In this case, an atherosclerotic plaque can break away from the endothelium at any time, regardless of its size. The result may be a blockage not of the carotid artery itself, butits branches that feed the brain. As a result, an ischemic stroke develops.
Indications for Carotid Endarterectomy
Surgery (carotid endarterectomy) is not for everyone. In order for the doctor to give permission for surgical intervention, there must be serious indications. Often, surgery is performed on patients who already have a history of cerebrovascular accident. So, in what cases is carotid endarterectomy justified? Indications for carrying out the following:
- The diameter of the vessel is more than half covered with atherosclerotic plaques.
- History of repeated strokes.
- Combination of hypertension (under compensation) and atherosclerosis of the carotid arteries.
Contraindications for surgery
Despite the benefits of surgical interventions, in some cases they cannot be performed. Like other operations, carotid endarterectomy also has contraindications. Reviews of patients suffering from atherosclerosis make it clear that many different examinations are performed before surgery. Only after the doctor is convinced that there are no contraindications, the patient begins to prepare for the operation. Carotid endarterectomy is prohibited in the following cases:
- Undrug-controlled (decompensated) hypertension.
- Extensive acute cerebrovascular accident.
- Unstable angina orrecent myocardial infarction.
- Acute heart failure.
- Recent stroke.
- Chronic circulatory failure 2nd and 3rd degree.
- Alzheimer's disease.
- Severe cancer.
Preparation for carotid endarterectomy
Before doing carotid endarterectomy, it is necessary to conduct various examinations. First of all, duplex ultrasound of the vessels of the head and neck is shown. Thanks to this method, the doctor can judge the degree of occlusion of the lumen of the arteries by atherosclerotic plaques. In some cases, vascular angiography is needed. This study consists in the introduction of a contrast agent 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 in certain areas 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, OAC, a biochemical blood 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 stage of the operation is anesthesia. The choice of anesthesia depends on the opinion of the doctor, as well as on the desire of the patient himself. Local anesthesia or general anesthesia may be performed. After that, 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 to clamp the vessel. Next, an incision is made on the carotid artery itself. After the doctor visually assesses the size and extent of the atherosclerotic plaque, he concludes how to proceed with the operation. There are several methods. Most often resort to open endarterectomy. This refers to the longitudinal dissection of the vessel and the "scraping" of cholesterol overlays. After that, a “patch” is applied to the site of the damaged endothelium. Another method is an eversion endarterectomy. To do this, the vessel is turned inside out and cleared 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 layer-by-layer suturing.
How is the postoperative period?
After a carotid endarterectomy, it takes time to restore blood flow. This takes several weeks. Since the incision in the neck is small, the pain is slightly expressed. Nevertheless, analgesics may be required on the first day. Also, you can not lift heavy objects and do physical exercises for several weeks from the moment the carotid endarterectomy was performed. The postoperative period proceeds well if performedall prescriptions of the doctor, and not only during the stay in the hospital, but also when the patient is discharged. The sutures are removed 7-10 days after the operation.
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. However, they occur and the patient should be warned about this.
The very first complication of the postoperative period is the failure of the sutures. With 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 arise 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.
Besides this, temporary voice and swallowing disorders are sometimes observed after the operation. This is due to damage to the nerve endings in the neck.
Restenosis is considered a later complication of carotid endarterectomy. This refers to the re-narrowing of the lumen of the vessel. Most often, restenosis occurs 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 do not depend on the patient, as they occur during surgery. Nevertheless, the prevention of other conditions is possible only through the combined work of the doctor and the 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 carrying out diagnostic procedures, the doctor gives the patient useful recommendations. First of all, this concerns lifestyle: the patient needs to give up smoking and alcohol, follow a diet (eat low-fat foods). Drug treatment is also prescribed to prevent restenosis. The patient must take lipid-lowering drugs (Atorvastatin) and antiplatelet agents (Cardiomagnyl and Clopidogrel tablets) every day.
Operation "carotid endarterectomy": pros and cons
Like all surgical procedures, this operation has both advantages and disadvantages. Some doctors do not recommend carotid endarterectomy as long as atherosclerosis can be treated conservatively and the patient is not clinically pathological. Other doctors believe that surgery is necessary when 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 cleaning of the vessel from cholesterol, improving blood flow. Surgery can significantly reduce the risk of stroke. However, endarterectomy does not guarantee that the vessel will not be damaged again. Complications such as nerve damage or stroke can also develop during the operation. Most doctors consider this manipulation to be a relatively benign procedure, and its results are considered significant.
Carotid endarterectomy: reviews of operated people
Positive and negative opinions are encountered when discussing any surgical treatment. Carotid endarterectomy is no exception. Reviews of operated people are different. In most cases, people are satisfied with the operation. Thanks to her, the symptoms of ischemia (impaired attention, memory, sleep) disappear, the results of the examination and the general condition improve. Some patients noted a change in voice, swallowing disorders after endarterectomy. In most cases, these symptoms lasted about a month, after which they completely disappeared.
