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Preventing Stroke Through Surgery With Carotid Endarterectomy

Preventing 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 detected?

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 consideration.

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.

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