Download Carotid Artery Disease

Carotid Endarterectomy
The gold standard and most successful treatment for
carotid artery disease is carotid endarterectomy. During a
carotid endarterectomy an incision is made along the side
of the neck and the carotid artery is then opened and the
atherosclerosis is removed. The artery is repaired with
either sutures or a small material
patch. This is done using general
anaesthesia. Most patients are
discharged from the hospital within
24 hours of undergoing the operation.
Carotid angioplasty and stenting technique (CAST)
Carotid angioplasty and stenting
is a relatively new procedure in
the treatment of carotid artery
disease in suitable patients. Its
implementation is limited to
patients who have received
radiotherapy to their neck in the
past, or have re-narrowing
(stenosis) of a carotid artery that
was previously treated.
In carotid angioplasty, a balloon
is attached to a catheter, a long tube, which is inserted in
the groin artery and threaded through the arteries to the
narrowed carotid artery. The balloon at the end of the
catheter is inflated to open the narrowed area, and a metal
stent, which is a kind of wire mesh tube, is left in place to
keep the artery from narrowing again.
Patients are awake during the procedure, and are usually
discharged from the hospital within 24 hours.
Protection of your Graft.
If you have a carotid patch or endovascular stent in place,
inform the relevant doctor or dentist if you are having
further surgery or any invasive procedure, such as an
angiogram. You may need ‘prophylactic’ antibiotics to
protect you from infection.
Screening Programme
Stroke is the third most common cause of death in Ireland
and is responsible for one in ten of all deaths. Treatment of
stroke, once it has occurred is generally unsuccessful.
Over 80% of all strokes are Ischaemic and the optimal
treatment for ischaemic stroke is primary prevention.
Carotid Artery Disease is easily and accurately identified
using ultrasound scanning. Once identified treatment of
predisposing conditions such as carotid artery disease
can reduce the incidence of stroke by up to 50%.
Creane A, Maher E, Sultan S, Hynes N, Kelly DJ, Lally C. A
remodelling metric for angular fibre distributions and its
application to diseased carotid bifurcations. Biomech Model
Mechanobiol. 2012 Jul;11(6):869-82. PMID:22086167
Maher E, Creane A, Sultan S, Hynes N, Lally C, Kelly DJ.
Inelasticity of Human Carotid Atherosclerotic Plaque. Ann
Biomed Eng. 2011 Sep;39(9):2445-55. PMID: 21618044
Sultan S, Hynes N Fast Track Carotid Surgery is the Gold
Standard for High-Risk (HRP) Carotid artery Intervention: Five
year cost-effectiveness and quality stroke free survival
comparison. J Am Coll Cardiol. 2011; 58 (20): Supp B149
Sultan S, Hynes N. Carotid Artery Endarterectomy (CEA) for
Stroke in Evolution (SIE): Technical and Long-term Clinical
Outcome in a Tertiary Referral Vascular Centre. When to
Master Silence? J Vasc Surg 2010; 51 (6) 43S
Lally C, Hynes N, Sultan S. Preclinical Medical Device Testing
and the Potential of Non-Invasive Imaging Carotid Artery
Intervention In High-risk Patients: Vascular 2008 16 (2) S103
Hynes N, Sultan S. Carotid Artery Stenting (CAS) Under Neuroprotection, Carotid Endarterectomy (CEA) And Best Medical
Therapy (BMT) for symptomatic patients with low Grey Scale
Median (GSM). Vascular 2008 16 (2) S108:
Sultan S. Contemporary Trends in Carotid Intervention: the
21st Century Approach to Carotid Endarterectomy, Carotid
Artery Stenting under Neuro Protection and Optimal
Medical Treatment Vascular 2008 16 (2) S108:
Sultan S. Carotid stump syndrome. A case report and
literature review. Int Angiol. 2004 Sep;23(3):284-7.
Review. PMID: 15765045
Prof Sherif Sultan, MB BCh MCh MD FRCSI DEVS
FISVS FASA DMD FRCS EBQS-VASC FACS, PhD
Depart of Vascular & Endovascular Surgery
Galway Clinic, Doughiska, Galway
Phone: +353 91 720122
Fax: 353 91 720121
E-mail: [email protected]
www.vascular.ie
Carotid Artery
Disease
A Guide for Patients
What is carotid artery disease?
Your arteries are responsible for delivering oxygen-rich
blood from your heart to other parts of your body. Your
carotid arteries are two main arteries that carry blood from
your heart, up through your neck, to your brain.
Healthy carotid arteries are smooth and unobstructed,
allowing blood to flow freely to the brain and provide
oxygen, glucose, and other nutrients that your brain cells
need. Typically with age, the carotid arteries build up
plaque, a sticky substance made up mostly of fat and
cholesterol. Plaque narrows the passageway within the
arteries and causes them to become stiff. Carotid artery
disease results when the carotid arteries become too narrow
or obstructed and limit the blood flow to the brain.
Strokes result either from obstruction of blood flow to the
brain by the plaque or when bits of plaque and clots break
off from the plaque and flow to the brain. If left untreated,
carotid artery disease may lead to stroke. Depending on its
severity, a stroke can be fatal. In fact, strokes are the third
leading cause of death in Ireland and the leading cause of
permanent disability in older adults.
Causes and risk factors
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Age (45years and older)
Hypertension (high blood pressure)
Diabetes
Smoking
High cholesterol
Obesity
Lack of exercise
Family history of atherosclerosis (hardening of the
arteries) and/or stroke
Irregular heartbeat, particularly atrial fibrillation (a
diagnosed condition where the heart chambers quiver
and beat ineffectively)
Symptoms and Warning signs
There may be no symptoms in the early stages of carotid
artery disease, and stroke could be the first sign of the
condition. Stroke, however, can have warning signs,
referred to as mini-strokes or transient ischemic attacks.
Mini-stroke symptoms are usually temporary, lasting a few
minutes to a few hours, and should be treated as serious
medical emergencies requiring immediate treatment
because they are strong predictors of future stoke.
Risk Factor Control
Some symptoms of stroke include:
» Weakness, numbness, or tingling on one side of the
body
» Inability to control movement of a body part
» Loss of vision or blurred vision in one or both eyes
» Inability to speak clearly
» Difficulty talking or comprehending what others are
saying
» Dizziness or confusion
Diagnosis
Stop Smoking
Low Fat Diet
Exercise
Control of High blood Pressure and Diabetes
Medical treatment
A combination of medication, called the ‘Magic Bullet’
is used to thin the blood, reduce the build-up of plaque
and lower blood pressure. This includes a combination of
blood thinning agents, statins and anti-hypertensive
medications
Diagnosis of carotid disease begins with a careful
medical history, including risk factors and physical exam
Doppler/Duplex Ultrasound It uses sound waves to
make images of your
carotid arteries. During
the test a special
ultrasound probe is
gently pressed against
your neck. An image
then forms on a monitor
the result shows how
severe the narrowing is.
Other Imaging Tests
Patients also have brain
imaging performed such
as CT scan, prior to surgery, that can show damage from
a past stroke. Some patients will have get an injection of
dye (contrast) during this CT scan to get a closer look at
their carotid arteries. If dye is used it is called a CT
Angiogram.
Treatment
Vascular surgeons are the only physicians who can
perform all the treatment options available, including
medical management, carotid endarterectomy and
minimally invasive endovascular angioplasty and stent
procedures. Only when you see a vascular surgeon who
offers all treatment modalities will you be assured of
receiving the care that is most appropriate to your
condition.
When is Intervention required?
Whether you need intervention or not depends on your
symptoms and how severely narrowed your carotid
artery is. In many cases patients are given best medical
treatment and followed up on a regular basis.
If you have mild narrowing but have had TIA’s you may
need surgery.
Even if you haven’t had any TIA symptoms, your risk of
having a stroke may still be high if one of your arteries is
severely narrowed. In that case intervention may also be
needed.