Operation to prevent stroke by repairing a narrowed artery in
the neck that supplies blood to the brain. The surgeon advises the patient
that surgery would be beneficial when the risk to the patient without surgery
is greater than the risk to the patient with surgery. Usually the patient is
given anaesthesia to put them to sleep. The surgeon makes a cut on the side of
the neck, usually from below the ear to just above the collar bone
(alternatively an incision across the neck is used). The arteries are
carefully identified with preservation of important structures in the neck.
The patients blood is thinned. Blood flow in the artery is stopped and the
artery is opened. The surgeon may insert a temporary shunt to maintain blood
flow to the brain during the operation. The surgeon removes the diseased inner
lining of the blood vessel. Then the hole in the blood vessel is repaired with
or without a patch. The shunt, if used, is removed. The surgeon then
stitches up the cut in the neck.
Alternatives
Do nothing, this will not decrease the patients risk of stroke.
Continue with risk factor reduction and drug therapy
Stop smoking
Control high blood pressure
Control Diabetes
Control high cholesterol
Take aspirin or alternative
Take statin
If the patient has had a mini-stroke and the artery is severely narrowed
then if the patient is treated as above the risk of a stroke within 2 years is
26%, however this risk falls to 4% if the patient also receives an
operation.
Consider enrolling in trial of experimental carotid angioplasty with
or without stenting
Benefits
Reduction in the risk of stroke
Risks
Risk of the anaesthetic
Risk of stroke or death of 3% to 5%
Bleeding, infection and ugly scar from any incision
Low risk of development of collection of blood in the neck that
may require a second operation
Unsteadiness and dizziness on going from lying to sitting, or
from sitting to standing, is very common in the first day or so but does not
persist
The skin of the neck may become numb, this may be temporary or
permanent, men are usually advised to use an electric razor initially
During the operation it may be necessary to displace the nerve
that moves the tongue. Following this handling the function of the nerve is
impaired and the tongue will protrude to the side of the operation initially.
Subsequently the nerve recovers and the tongue protrudes as per usual. Rarely
other important nerves in the neck may be damaged, this may result in a change
in voice in a small number of patients
Risk of urinary retention in men
Risk of Deep Venous Thrombosis and its sequelae
Longer term risk of infection of plastic patch if this is used
Longer term risk of narrowing of the operated artery. A minor
degree of narrowing is common due to healing of the artery, however this does
not usually progress to a severe narrowing. Occasionally the artery may narrow
to such an extent that it becomes blocked. Usually, the narrowing does not
cause any problems as it is due to healing of the artery and not from
collection of atheroma in the artery.
