Carotid Endarterectomy

CAROTID ENDARTERECTOMY

Carotid endarterectomy is a surgical procedure designed to remove atherosclerotic plaque in the critically strategic location of the carotid bifurcation in the neck. The objective of the operation is to reduce the risk of stroke and stroke related death and disability. It has been estimated that more than 50% of strokes are related to plaques in the carotid bifurcation. The mechanism for stroke is the breaking off or fragmentation of the plaque into fragments that are carried by flowing blood to the brain in a process called embolization. In addition to the embolic potential of the plaque, the plaque itself can continue to expand until blood flow though the internal carotid artery is shut off causing the vessel to clot with the risk of pushing the clot into the blood vessels within the brain resulting in the death of an area of the brain supplied by the clotted artery.

The most compelling indication for carotid endarterectomy involves patients who have or who currently are experiencing symptoms, so called transient ischemic attacks(TIAs) or who have had a stroke but made a good recovery but are at risk of having another stroke. The other major indication for operation include patients who have not yet experienced symptoms but have a critical narrowing of the carotid artery which, if left untreated, may result in a stroke.

There are risks associated with carotid endarterectomy which include death, stroke, or injury to cranial nerves. Over the years these risks have been progressively reduced, making carotid endarterectomy one of the safest and most effective of all surgical procedures. The risk of complications are related to the competence of the individual surgeon, but the current national average risk of death and stroke for operating on the asymptomatic patient is 1.5% and for operating on the symptomatic patient is 3.75%.