Doctor explains Carotid Endarterectomy | Procedure, benefits, risks and recovery

In this video, I delve into the critical topic of carotid endarterectomy and its role in stroke prevention. If you've been advised that you need this procedure, you likely have many questions swirling in your mind. This video aims to break down the complexities surrounding carotid endarterectomy, making it easier for you to understand what to expect and how it can impact your health.

Carotid endarterectomy is a surgical procedure designed to remove fatty deposits, known as plaques, that accumulate in the carotid arteries. These arteries, located on either side of your neck, are responsible for supplying blood to your brain, face, and neck. When plaque builds up, it can lead to carotid artery disease or carotid artery stenosis, which narrows or blocks these vital arteries. If left untreated, this condition can significantly reduce blood flow to the brain or even cause a clot to form, leading to a stroke or a transient ischemic attack (TIA), often referred to as a mini-stroke. Alarmingly, around one in four strokes in the UK are attributed to narrowing of the carotid arteries, making this procedure not just routine but potentially life-saving.

So, when is carotid endarterectomy necessary? Surgery is typically recommended if your carotid artery is narrowed by more than 50% and you've recently experienced a stroke or TIA. Even if you haven't had symptoms, severe narrowing detected through tests may warrant surgery. Ideally, the procedure should be performed within two weeks of the onset of symptoms to maximize the chances of preventing another stroke. However, if your artery is only mildly narrowed (less than 50%) or completely blocked, the risks of surgery may outweigh the benefits.

Understanding the causes of carotid artery disease is essential. This condition develops when fatty substances accumulate on the inner walls of arteries, a process known as atherosclerosis. Several risk factors contribute to this buildup, including aging, high-fat diets, high blood pressure, diabetes, and smoking. When plaque accumulates, it can lead to ischemic strokes if the artery becomes completely blocked or embolic strokes if a piece of plaque breaks off and obstructs a smaller artery in the brain.

Diagnosis of carotid artery disease often occurs after symptoms of a stroke or TIA manifest, such as facial drooping, limb weakness or numbness, slurred speech, or sudden vision loss. In some cases, individuals may be diagnosed incidentally during tests for unrelated conditions, a situation known as asymptomatic carotid stenosis. To confirm the diagnosis and assess severity, healthcare providers may use a duplex ultrasound, CT scan, or MRI to evaluate blood flow and visualize the arteries. The severity of narrowing is graded using the NASCET scale, which categorizes it into minor (less than 49% narrowed), moderate (50-69% narrowed), and severe (70-99% narrowed). Surgery is generally considered for those with moderate or severe narrowing.

Before undergoing surgery, you'll attend a pre-assessment clinic where your medical history, medications, and allergies will be reviewed. Blood tests and a physical examination will also be conducted. This is an excellent opportunity for you to ask any questions or express concerns. Your surgeon may advise you to stop smoking to reduce infection risk and promote healing, and adopting a healthier lifestyle can significantly aid your recovery.

On the day of the procedure, carotid endarterectomy can be performed under general anesthesia, where you will be asleep, or local anesthesia, where you remain awake but your neck is numbed. The choice depends on your health, your surgeon's preference, and your comfort level. During the surgery, a small incision is made in your neck to expose the carotid artery, which is then clamped to halt blood flow. A shunt may be used to redirect blood during the procedure. The surgeon will remove the plaque and close the artery, either with stitches or a patch. The entire process typically takes about one to two hours.

Recovery after carotid endarterectomy is generally straightforward. You'll be monitored in a recovery area or high-dependency unit, where your vital signs will be closely observed. Most patients can eat and drink within a few hours and are usually discharged within one to two days. You'll receive instructions on wound care, and while the scar may take a few months to fade, special creams can help with the healing process. Driving is typically safe after two to three weeks, but this may vary based on individual circumstances, especially if you've had a stroke or TIA.

As with any surgical procedure, there are risks involved. The most significant risks include stroke (approximately 2%) and death (less than 1%). Other potential complications include bleeding or infection at the incision site, nerve damage leading to hoarseness or numbness (affecting about 4% of patients), and re-narrowing of the artery, which may require further surgery in 2-4% of cases. Your surgical team will discuss these risks with you beforehand, ensuring you can make an informed decision.

For those who may not be suitable candidates for carotid endarterectomy, an alternative option is carotid artery stenting. This less invasive procedure involves inserting a stent to keep the artery open, typically performed under local anesthesia with an overnight hospital stay. However, stenting carries a slightly higher risk of stroke in the short term, particularly if performed shortly after symptoms arise, which is why carotid endarterectomy is often the preferred first-line option.

If you found this video helpful, please consider giving it a thumbs up. If you or someone you know has undergone this procedure, I encourage you to share your experiences in the comments section below. Your insights could be invaluable to others navigating this journey. Thank you for watching, and take care.

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