written by: Elizabeth Stannard Gromisch
• edited by: Leigh A. Zaykoski
• updated: 12/8/2010
A form of treatment for carotid artery disease, carotid artery surgery prevents future strokes by removing plaques from the carotid arteries in the neck. However, there are risks in carotid artery surgery. Learn about carotid artery surgery, its risks, and what are stents.
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Carotid artery surgery is a procedure to remove plaques from the arteries on the side of the neck. The National Heart, Lung and Blood Institute (NHLBI) states that plaque, which is a buildup of “fat, cholesterol, calcium and other substances found in the blood," prevents adequate blood flow to the brain. When the brain does not get enough blood, the lack of oxygen results in cell death. A serious consequence of untreated carotid artery disease (plaque buildup in those arteries) is a stroke, which can cause severe brain damage or even death. Both types of carotid artery surgery can prevent a stroke from occurring, though they do carry certain risks.
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Types of Carotid Artery Surgery
MedlinePlus states that two types of carotid artery surgery are done to remove plaque: carotid endarterectomy and carotid angioplasty and stenting. Carotid endarterectomy, which is done while the patient is under anesthesia, is the most invasive form of carotid artery surgery. The procedure begins with an incision made over the carotid artery, followed by an insertion of a catheter to move the blood away from the blocked artery during the surgery. The carotid artery is then opened, the plaque is removed and the artery is sewn up. Because the carotid artery is a major artery between the brain and the heart, both organs are monitored closely for any distress or change in function.
The other surgical option, carotid angioplasty and stenting, is the less invasive form of carotid artery surgery. MedlinePlus notes that during carotid angioplasty and stenting, fluoroscopy, a type of x-ray, is used to view the blocked artery. Like carotid endarterectomy, an incision is made for the insertion of a catheter; however, the angioplasty incision is made by the groin while the patient is numbed. Once inserted, the catheter is guided up towards the blocked artery. The balloon at the end of the catheter is pushed into the blockage. Once there, it is blown up and pressed against the wall of the artery to open it up. Once blood flow resumes normally, the balloon is removed.
If the inflated balloon is not enough to keep the blocked artery open, a stent may be inserted at the same time as the balloon. MedlinePlus states that a stent is a tiny tube that can be made of plastic mesh-like material or metal. Unlike the balloon, the stent is left in the artery.
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Benefits and Risks in Carotid Artery Surgery
The main benefit of carotid artery surgery is to reduce the risk of a stroke in a patient with carotid artery disease. The NHLBI states that this procedure is most helpful in carotid artery disease patients who have had either a prior stroke or a transient ischemic attack (TIA), which is also known as a “mini stroke." However, like other surgical procedures, there are risks in carotid artery surgery. MedlinePlus states that risks include bleeding in the brain, brain damage, swelling near the airway, heart attack and more blockage of the carotid artery over time. In rare cases, the patient may suffer from a stroke or seizure. A patient getting carotid artery angioplasty is also at risk for an allergic reaction to the dye or stent material.
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MedlinePlus Medical Encyclopedia: Carotid Artery Surgery (http://www.nlm.nih.gov/medlineplus/ency/article/002951.htm)
National Heart, Lung and Blood Institute: Carotid Endarterectomy