Carotid Endarterectomy

What is a carotid endarterectomy?
Carotid endarterectomy is a surgical procedure in which a doctor removes fatty deposits from the carotid arteries, the two main arteries in the neck supplying blood to the brain. Problems with the carotid arteries become common and dangerous as people age or do not maintain healthy lifestyles and control medical problems like high cholesterol. Fatty deposits, or "plaque", can build up on artery walls, blocking blood flow and leading to atherosclerosis, which is also called "hardening of the arteries". Almost 90 percent of strokes are caused by a blood clot or blockage of a blood vessel.

While atherosclerosis and high cholesterol can often be managed with drugs called "statins", sometimes surgery is necessary to prevent a stroke. Cartoid endarterectomy has been a stroke prevention measure for more than 40 years and is the most common surgery for removing fatty deposits in the U.S. Today, the surgery is proving more successful than ever in preventing stroke, reducing risk by as much as 55 percent.

Carotid endarterectomies can help prevent stroke in those patients that have already experienced a stroke or symptoms of a stroke, as well as those people who have severe atherosclerosis (stenosis of 60 percent to 99 percent). Studies have shown this surgery can reduce the estimated 2-year risk of stroke by more than 80 percent, while other studies show the estimated 5-year risk of stroke is reduced by half.

What other surgery can help with carotid artery disease?
Arterial Bypass Surgery is a type of surgery that has failed to show any benefit for stroke prevention, but it was developed as a way to re-establish blood flow to the brain when an internal carotid artery is blocked. Surgeons make a hole in the cranium and connect an artery serving the face or head to an artery serving the brain.

How is carotid artery disease diagnosed?
In most cases, the disease can be detected during a normal checkup with a doctor, who might order the following tests:

History and physical exam: A doctor will ask about stroke symptoms such as numbness or muscle weakness, speech or vision difficulties or lightheadedness. Using a stethoscope, a doctor may hear a rushing sound, called a bruit (pronounced "brew-ee"), in the carotid artery. Unfortunately, some blockages with a low risk can make a significant sound but dangerous levels of disease some times fail to make a sound at all.

Doppler ultrasound imaging: This is a painless, noninvasive test in which sound waves above the range of human hearing are sent into the neck. Echoes bounce off the moving blood and the tissue in the artery and can be formed into an image. Ultra-sound is fast, risk-free, relatively inexpensive and painless. In carefully calibrated ultrasound laboratories, ultrasound studies can be up to 95 percent accurate and offer visualization of the anatomy, evaluation of the blood flow rate and turbulence and characterization of the plaque when performed by a skilled technician.

Oculoplethysmography (OPG): This procedure measures the pulsation of the arteries in the back of the eye. It is used as an indirect check for blockages in the carotid arteries.

Computed tomography (CT) Scan: This test produces a series of cross-sectional X-rays of the head and brain. It can't detect carotid artery disease but may be ordered by a doctor to investigate other possible causes of symptoms. The test is also called a CAT scan, for computer assisted tomography.

Arteriography and Digital Subtraction Angiography (DSA): Arteriography is an X-ray of the carotid artery taken when a special dye is injected into another artery in the leg or arm. A burning sensation may be felt when the dye is injected. DSA is also an X-ray study of the carotid artery. It is similar to arteriography except that less dye is used. These invasive procedures are more expensive and carry their own small risk of causing a stroke.

Magnetic Resonance Angiography (MRA): This is a new imaging technique that is more accurate than ultrasound, yet avoids the risks associated with X-rays and dye injection. An MRA is a type of magnetic resonance image that uses special software to create an image of the arteries in the brain. A magnetic resonance image uses harmless but powerful magnetic fields to create a highly detailed image of the body's tissues.

Frequently these procedures are carried out in a stepwise fashion: from a doctor's evaluation of symptoms to ultrasound, with arteriography, DSA or MRA reserved for difficult diagnoses.

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