Carotid Surgery for Stroke Prevention

Fatty deposits can build up in the carotid arteries in the neck, narrowing the vessels and increasing your risk of stroke; this is called carotid artery disease, or carotid artery stenosis. Often there are no symptoms until the condition progresses to the point of causing a stroke or transient ischemic attack (TIA).

The main symptoms of a TIA can be remembered with the word FAST:
Face – the face may have dropped on 1 side, the person may not be able to smile, or their mouth or eye may have dropped.
Arms – the person may not be able to lift both arms and keep them raised because of weakness or numbness in 1 arm.
Speech – their speech may be slurred or garbled, or the person may not be able to talk at all, despite appearing to be awake; they may also have problems understanding what you’re saying to them.
Time – it’s time to call 999 immediately if you see any of these signs or symptoms.

Carotid artery disease is usually diagnosed after brain imaging following a stroke or TIA; or it may be picked up during unrelated tests.

There are two options for treatment, and Mr Oluwole will be able to advise on the best course of action for you.

Carotid Endarterectomy

During this surgery, a cut will be made in the neck just below the corner of your jaw to allow access to the carotid artery and then a small cut will be made in the carotid artery to manually remove the build-up. This can be done under local or general anaesthetic. The surgeon may put in a shunt, which allows blood to go around the surgery site and continue flowing from the heart to the brain during the operation, and a drainage tube to drain any blood from the area at the end of the operation. After the blockage is removed, the artery and the skin are stitched closed. The drainage tube is usually removed the day after surgery.

Most patients are able to go home 1-2 days after the procedure and can return to work 2-4 weeks after. Following surgery, the risk of stroke is significantly reduced, and lifestyle changes- such as stopping smoking and eating healthily- will help maximise this benefit.

Risks

There is a risk of heart attack, and a risk of stroke- which is higher if you have had a stroke previously. Pain, numbness and bleeding at the wound site are common. There is also a risk of nerve damage, though this generally resolves itself within a few months, and a risk of re-narrowing of the carotid artery (restenosis) which would require further surgery to treat.

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

Carotid stenting

Carotid artery stenting is a less invasive treatment for carotid artery disease and involves using a metal mesh tube to widen the artery. It is usually performed under local anaesthetic and can be a good alternative for patients that are unsuitable for surgery- for instance, due to previous nerve damage in the area or arteries that are difficult to reach surgically. First, a flexible tube called a catheter is inserted into the vessel through a cut in the groin area and fed up through the body to the affected section. A balloon at the end of the catheter is inflated to widen the artery, and the stent is then put in place to keep the vessel open.

Most patients can return home the next day. The risk of stroke is slightly higher after carotid stenting compared to a carotid endarterectomy, but the long-term reduction in stroke risk is largely the same for the two procedures. You may also need to take medication to reduce the risk of blood clots following the insertion of a stent.

Risks

Bleeding and bruising are common at the site where the catheter is inserted. There is also a risk of infection, and a risk of damage to the arteries during the procedure, both of which will be minimised as far as possible by the surgical team. The risk of stroke is slightly elevated during and after the procedure- but will be lower than if the condition was left untreated. There is also a possibility your arteries may narrow again (restenosis), requiring further treatment.

During your initial consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.