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1. What is the problem?
Every day in Great Britain, many people have a stroke ("CVA" - Cerebrovascular Accident) or warning signs of a stroke ("mini stroke" or "TIA" - Transient Ischaemic Attack). Such patients are at a higher risk of having another, perhaps major, stroke. All patients with an increased risk of stroke are given medical treatment and advice to reduce this risk. This includes treatment of high blood pressure, diabetes, high fat levels, heart disease and stopping smoking. In addition, aspirin is generally given.
However, in many cases, surgical treatment is also recommended. In these cases, such as yourself, there is a narrowing of the artery in your neck that supplies blood to the brain. This trouble is due to hardening of the arteries (atherosclerosis). It is important to realise that the left side of the brain looks after the right arm and leg and the right side of the brain looks after the left arm and leg. For this reason, the patient often thinks that the "wrong" side is being operated upon when in fact it is the correct side!
At present, we also know that the presence of a narrowing (stenosis) in your carotid artery makes the chances of suffering a stroke in the future much higher than in a person without such a narrowing. We also know that performing an operation called carotid endarterectomy (to correct the narrowing) will actually reduce the chances of stroke and /or death significantly.
2. Before the operation.
Surgery involves admission to hospital for about four days and will generally be carried out on the day after admission. Before the operation you will be seen by the anaesthetist who will examine you, and by one of the surgical team who will explain anything that you are not sure about. Your nurse will also explain the ward routines and will answer any questions that you may have. You will have a number of pre-operative tests including blood tests, a cardiogram, a chest x-ray and usually a further ultrasound scan of your neck to ensure there has been no change in the carotid artery since the previous one. You will be asked to eat or drink absolutely nothing for 6 to 12 hours before the operation. If you feel unable to sleep, please ask the nurses or doctor to give you a sleeping tablet to allow you plenty of rest. About one hour before the operation you will be given a sedative.
3. The operation.
The operation may be performed under General or Local anaesthetic. With Local anaesthetic you receive an injection into the side of the neck in order to numb the area. You are awake throughout the operation and there will be a nurse talking to you. Once you have been anaesthetised a cut is made in the skin of the neck over the carotid artery. The artery is then temporarily clamped off and the diseased lining removed. The artery is then closed. Sometimes a patch of synthetic material is used to prevent narrowing. Alternatively, the artery may simply be stitched up. Either metal staples or stitches will be used to close the skin and there may be a drainage tube placed which will be taken out after 24 or 48 hours.
Operative photographs
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