Stroke through Surgery with Carotid Endarterectomy
Each year, 400,000 to 600,000
Americans suffer a stroke. Fully half of these debilitating cerebrovascular
accidents are caused by carotid artery disease, a condition that can be
corrected by surgery before the stroke occurs.
What is carotid artery disease?
Carotid artery disease is the
manifestation of an underlying condition called atherosclerosis, or
"hardening of the arteries," which is a narrowing of the vessels that
carry blood from the heart to the body's tissues and organs. This condition is
caused by the buildup of plaque on the inside arterial walls. Carotid artery
disease occurs when the walls of the carotid arteries, which carry blood from
the heart to the head, become narrow from plaque accumulation, blocking blood
flow to the brain.
How is carotid artery disease
Your primary care physician can help
you identify your risk factors for carotid artery disease during your annual
physical examination. You are at increased risk if you are a smoker, and if you
have high blood pressure, elevated cholesterol, diabetes, or a family history
of carotid artery disease. Your risk also increases with age.
Some people with carotid artery
disease do experience symptoms prior to a stroke that alert them to their
existing problem. Transient ischemic attacks-when a small fragment of plaque
becomes loose and lodges in the brain, causing temporary paralysis of an arm or
leg, dizziness, loss of vision, or slurred speech-are a common symptom. Another
is amaurosis fugax, which is temporary blindness in one eye.
Often people with carotid artery
disease have no symptoms. However, by listening to the blood flow in your neck
with a stethoscope, your doctor can hear the telltale sound of blood pushing its
way through narrowed arteries. Best described as a "whooshing" sound,
it is similar to the turbulence of river rapids, as the water is forced to flow
through a narrowing in the riverbed.
Suspected carotid artery disease is
confirmed by a painless, non-invasive ultrasound examination, called a duplex
scan. Locally, this test is performed in the vascular laboratory at Cayuga Medical
Center, using color
Doppler technology. This technology provides a high degree of accuracy
regarding the percentage of stenosis, or narrowing, in the arteries.
Determining the percentage of stenosis is extremely important because large
studies have proven that patients with significant narrowing benefit
dramatically from a surgical approach to treatment.
What is the surgery like?
The procedure to remove plaque
buildup from the inside of the carotid arteries is called carotid
endarterectomy. It is an inpatient surgical procedure and should be performed
by a surgical team with experience in this particular type of vascular surgery.
The carotid arteries are located
very superficially in the neck, giving the surgeon easy access to them. During
surgery, the plaque buildup is carefully removed from the artery wall,
restoring the flow of blood to the brain. This procedure is best performed
under regional anesthesia (usually a cervical block), which means that the
patient is awake. This is important because it allows the surgical team to test
the patient's neurological function during surgery. The expertise of
administering these cervical blocks is not available everywhere; many medical
centers use general anesthesia which can increase the patient's risks.
From the recovery room, the patient
is taken to the intensive-coronary care unit for close monitoring. Most
patients experience minimal discomfort, and are ready to go home within a
couple of days.
The cost of a stroke, both in terms
of human suffering and financial expense, can be staggering. Rehabilitation
following a stroke is long and difficult, and many people never fully recover.
Prevention of strokes becomes very important, and for patients with significant
carotid narrowing, a surgical approach to treatment is worth serious
Carotid endarterectomy is performed at Cayuga Medical Center by Dr.
William Phillips, who is board certified in both vascular and general surgery. He
is in practice with Surgical Associates of Ithaca and can be reached at (607) 273-3161.