Carotid endarterectomy: indications, postoperative period, complications, reviews of operated, pros and cons

Everyone knows that stroke is considered to be one of the most common causes of death among the population of the whole planet. This disease occurs with the same frequency in all countries of the world. Often, impaired cerebral circulation leads to paralysis and paresis, causing a temporary or persistent disability. To avoid the development of this disease, it is necessary to diagnose the provoking factors of stroke in time and to fight them. The main cause of ONMI is atherosclerosis of the arteries of the neck and head. Clogging of vessels in elderly and senile age is observed practically at all. Most people over 60 years of age perform medical prophylaxis for atherosclerosis. In some cases, treatment with drugs no longer has the desired effect. Then the operative intervention - carotid endarterectomy is shown. This procedure consists in removing the portion of the vessel damaged by atherosclerosis.

Why Carotid Endarterectomy?

Blood supply of the brain depends on the condition of the carotid arteries. These vessels are branches of the aorta. They are located symmetrically on both sides of the neck. Entering the cavity of the skull, carotid arteries are divided into smaller brain branches. In patients suffering from atherosclerosis, there is a 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 come off the vessel wall and enter the brain. As a result, they cause ischemia - insufficient supply of oxygen to the tissues. Such a violation of cerebral circulation leads to terrible consequences. To prevent a stroke, carotid endarterectomy is performed. It helps to prevent ONMK and its consequences.

Description of the procedure

Carotid endarterectomy is an operative intervention, which consists in cleaning the inner layer of the vessel from an atherosclerotic plaque. It is performed in those cases when drug treatment is powerless or the risk of development of ONMC is too high. Medicines are not able to have the proper 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 increases significantly in the presence of uncontrolled hypertension. In this case, the atherosclerotic plaque can at any time come off the endothelium, regardless of its size. The result can be a blockage of not the carotid artery itself, but its branches that feed the brain. As a result, ischemic stroke develops.

Indications for carotid endarterectomy

The operation (carotid endarterectomy) is not carried out by everyone. In order for a physician to give permission for surgery, there must be serious indications. Often, the operation is done for patients who have a history of a previous impaired cerebral circulation. So, in what cases is carotid endarterectomy justified? Indications for the following:

1. The diameter of the vessel is covered by atherosclerotic plaques more than half.
2. Repeated strokes in the anamnesis.
3. Combination of hypertension (in the stage of compensation) and atherosclerosis of the carotid arteries.

Contraindications to the operation

Despite the benefits of surgical interventions, in some cases they can not be performed. Like other operations, contraindications have also carotid endarterectomy. The testimonies of patients suffering from atherosclerosis make it clear that many different examinations are performed before the surgery. Only after the doctor is convinced of the absence of contraindications, the patient begins to prepare for surgery. Carotid endarterectomy is prohibited in the following cases:

1. Uncontrolled drugs (decompensated) hypertensive disease.
2. Extensive acute disorder of cerebral circulation.
3. Unstable angina or recently suffered myocardial infarction.
4. Acute congestive heart failure.
5. Recently suffered stroke.
6. Chronic circulatory failure of 2 and 3 degrees.
7. Alzheimer's disease.
8. Oncological diseases of a serious degree.

Preparation for carotid endarterectomy

Before making carotid endarterectomy, it is necessary to conduct various examinations. First of all, a duplex ultrasound of the vessels of the head and neck is shown. Thanks to this method, the doctor can judge the degree of closure of the lumen of the arteries by atherosclerotic plaques. In some cases, angiography of the vessels is necessary. This study consists in the introduction of a contrast medium into the blood followed by X-ray control. A more accurate method is CT angiography. It allows to assess the shape, size and localization of cholesteric overlap on the endothelium. If the doctor suspects ischemia of certain areas of the brain, magnetic resonance imaging is performed. When the doctor has revealed the indications for the operation, he needs to make a conclusion about the general condition of the patient. To do this, before the carotid endarterectomy, ECG, UAC, give a biochemical blood test and a coagulogram. If the patient has other pathologies, then a 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 patient's desire. Local anesthesia or general anesthesia may be performed. After this, the surgeon makes an incision in the area where ultrasound or angiography results in a cholesteric plaque. The next step is the clamping of the vessel. Further the incision is made on the carotid artery. After the doctor visually assesses the size and extent of the atherosclerotic plaque, he concludes how to continue the operation. There are several methods. Most often resort to open endarterectomy. By this is meant the longitudinal dissection of the vessel and the "scraping" of the cholesterol imposition. After this, the place of the damaged endothelium is superimposed with a "patch". Another method is an eversion endarterectomy. To do this, the vessel is turned inside out and cleared of atherosclerotic masses. If the lesion of the carotid artery is large, it is replaced at a certain site. To do this, use synthetic fabrics. The final stage of carotid endarterectomy is layer-by-layer stitching.

How is the postoperative period?

After carotid endarterectomy, it takes time to restore blood flow. This takes a few weeks. Since the incision in the neck area is small, the pain sensations are not very pronounced. Nevertheless, in the first day, analgesics may be required. Also, do not lift heavy objects and exercise for several weeks from the time the carotid endarterectomy was performed. The postoperative period proceeds well if all the prescriptions of the doctor are fulfilled, not only during the stay in the hospital, but also when the patient is discharged. Sutures are removed for 7-10 days from the time of surgery.

Complications of carotid endarterectomy

It should be remembered that any surgical intervention entails risks. Not an exception and carotid endarterectomy. Complications after this operation are rare, in about 3% of cases. Nevertheless, they occur, and the patient should be warned about this.

The very first complication of the postoperative period is the inconsistency of the sutures. In this operation, the penetration of bacteria into the wound is very dangerous for the patient's life, since the incision is carried out directly on the vascular bed. This complication can arise due to non-compliance with the rules of antiseptics.

Another dangerous condition associated with carotid endarterectomy is a stroke. Acute disturbance of cerebral circulation can arise as a result of detachment of a fragment of an atherosclerotic plaque during the operation and getting it into the vessels of the head. This complication is rare, in 2-3% of cases.

In addition, after the operation, there are sometimes temporary disorders of voice and swallowing. This is due to damage to the nerve endings that are in the neck area.

A later complication of carotid endarterectomy is restenosis. By this is meant a repeated narrowing of the lumen of the vessel. Most often, restenosis is observed in patients who do not follow the doctor's instructions.

Prevention of postoperative complications

Such complications, as a stroke and damage to the nerve endings of the neck, do not depend on the patient, as they arise during surgery. However, the prevention of other conditions is possible only thanks to the combined work of the doctor and the patient. Especially it concerns the repeated occurrence of atherosclerotic plaques. After the operation is left behind, the patient must constantly be observed by a specialist. In addition to conducting diagnostic procedures, the doctor gives the patient useful advice. First of all, it concerns the way of life: the patient should give up smoking and alcohol, keep to a diet (eat low-fat foods). Also for the prevention of restenosis prescribe medication. The patient should take lipid-lowering drugs every day (drug "Atorvastatin"), antiaggregants (tablets "Cardiomagnolo", "Klopidogrel").

Operation "carotid endarterectomy": pro and contra

Like all surgical procedures, this operation has both advantages and disadvantages. Some doctors do not recommend carotid endarterectomy until atherosclerosis can be treated conservatively, and the patient has no clinical manifestations of pathology. Other doctors believe that surgery is necessary with a significant narrowing of the artery lumen, regardless of whether the patient has symptoms or not. The advantage of this procedure is a complete cleaning of the vessel from cholesterol, an improvement in blood flow. The operation allows you to significantly reduce the risk of stroke. Nevertheless, endarterectomy does not guarantee that the vessel will not be damaged again. Also during the operation, complications can occur in the form of nerve damage or stroke. Most doctors attribute this manipulation to relatively harmless procedures, and its results are considered significant.

Carotid endarterectomy: reviews of operated people

Positive and negative opinions are found when discussing any surgical treatment. Not an exception and carotid endarterectomy. The responses of the operated people are different. In most cases, people are happy with the operation. Due to her symptoms of ischemia (violation of attention, memory, sleep), the results of examination and general condition improve. Some patients noted a change in voice, a violation of swallowing after endarterectomy. In most cases, these symptoms lasted about a month, after which they completely disappeared.