What is Strokes, Carotid Artery Disease ?
A stroke is a brain attack.
The goal of carotid surgery and carotid artery stenting is to prevent strokes. Strokes lasting less than 24 hours are referred to as transient ischaemic attacks.
Different types of stroke
There are three different types of stroke; ischaemic strokes, haemorrhagic strokes and transient ischemic attacks.
An ischaemic stroke is caused by a blockage cutting off the blood supply to the brain. This is the most common type of stroke.
A haemorrhagic stroke is caused by a bleeding in or around the brain.
A transient ischaemic attack or TIA is also known as a mini-stroke. It is the same as a stroke, except that the symptoms only last for a short amount of time. This is because the blockage that stops the blood getting to your brain is temporary.
What is the risk of major stroke after a min-stroke?
A patient who presents with amaurosis fugax, TIA or stroke associated with a stenosis of the relevant internal carotid artery greater than 70% has a high risk of major stroke in the following 3 months. Correcting vascular risk factors (stopping smoking, treating hypertension, instigating aspirin and statin therapy) go some way to reduce this risk but correcting the underlying carotid artery disease by operation or stenting is highly effective at reducing subsequent stroke risk down to normal levels.
What is carotid endarterectomy?
Carotid endarterectomy is an operation to unblock damaged arteries supplying the brain which cause strokes if left untreated. The operation involves exposing the carotid arteries, opening the vessel and carefully removing the diseased plaque leaving a smooth internal lining.
The operation takes about 60-90 minutes and most patients are discharged home 24 to 48 hours post-op.
Side effects and problems of carotid surgery
Carotid endarterectomy has a risk of death and stroke of around 2-3% depending upon the operating surgeon and patient risk factors.
The other main complication is damage to important nerves in the area. The most important ones are the hypoglossal nerve which controls the tongue, mouth, and branches of the vagus nerve which supply the voice box.
Carotid artery stenting
Carotid artery stenting is a relatively new way of correcting blockages of the carotid arteries with the same goal as carotid endarterectomy; to reduce risk of stroke. The procedure is done under local anaesthetic.
A balloon is inserted along the wire across the blocked artery, and the balloon inflated to open up the area of narrowing. A stent (fine metal mesh tube) is then inserted to hold the artery open after the balloon has been withdrawn. The procedure takes about an hour and discharge is within 24 hours.
Potential side effects of carotid artery stenting
The problem with passing wires, catheters and balloons past a diseased artery is that it may cause debris to break off and lodge in the brain causing a stroke.
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