Carotid Surgery

Carotid Surgery

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Overview


By far the most common operation for carotid disease is for a significant carotid stenosis in the context of a stroke. Non-atheromatous carotid disease is briefly discussed at the end of this chapter.


Context


Carotid endarterectomy or stenting is indicated following a stroke or TIA affecting the carotid territory of the appropriate side. Carotid surgery is now considered an urgent treatment because it has become clear that a TIA can be a warning sign of impending further TIAs or major stroke; hence, in general, the sooner the carotid surgery, the bigger the risk reduction benefit. Within 2 weeks is considered acceptable. Beyond this the benefit reduces weekly, especially in women.


Carotid Endarterectomy


Procedure



  • An incision is made in the neck along the anterior border of the sternocleidomastoid muscle.
  • The incision is deepened through platysma and fascia. The internal jugular vein is mobilised posterolaterally and its branches divided.
  • The common, external and internal carotid arteries are dissected.
  • The arteries are clamped and the patient’s cerebral function is monitored.
  • The artery is opened longitudinally (arteriotomy).
  • The plaque, along with the intima and media, is dissected out of the artery, leaving only the thin adventitia.
  • The artery is thoroughly inspected for loose debris.
  • The artery is closed with or without a patch.
  • The wound is closed.

Controversies


For a common operation with a huge amount of scientific data behind it, there is still considerable debate in carotid surgery. The principal controversy is how do you monitor

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Jul 1, 2016 | Posted by in CARDIOLOGY | Comments Off on Carotid Surgery

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