Stroke is one of the very serious problem which causes severe impairment to person, a big financial burden on family and often it is life threatening.
Out of the various causes which cause stroke Carotid artery narrowing is one of the main and treatable cause. Carotid arteries are the main blood supply to brain, one on each side arising from big vessel –Aorta – and going on each side of neck under the muscles and there are two vertebral arteries which run in a tiny hole in our spine bone in the neck.
Patients who had symptoms of stroke or mini –stroke which include Sudden loss of sensation and/or function in one of the limbs, sudden loss of speech or sudden loss of vision in one eye with typical description of curtain coming in front of eye should quickly consult a specialist and should have a scan to see how much their Carotid arteries are narrowed along with investigations for other causes of the problem.
MR Angiogram – Left carotid bifurcation narrowing and filling defect from CCA to ICA
The scans will clarify what is the status of their carotid arteries, the degree of narrowing and any irregularity in lining and fresh blood clots sitting in that area – all the above findings are very important to know as the situation needs urgent further investigations and management.
When the carotid artery is narrowed more than 50 to 70 % and the inside lining is very irregular with fresh blood clots, sometimes clearly seen on various modalities of investigation, there is a very high chance that they will have another serious episode of stroke which can be prevented.
Atherosclerotic Plaque with ulceration in the centre with fresh Clot- can cause serious stroke
Carotid Endarterectomy- which is removing the damaged lining inside the carotid artery and repairing the artery is one of the well established treatments for reducing the risk of a life threatening stroke in people who had mini- stroke (TIA) symptoms. These operations are done by highly Specialized Vascular Surgeons and need a detailed discussion for the need of the procedure, possible outcomes and risks and benefits.
There are no well established, equally effective and durable alternatives when the carotid arteries are severely narrowed. Some specialists propose inserting a Stent (a metal spring) inside the artery and widening it. Inserting a stent was rigorously evaluated against Carotid surgery and the research has not been shown anywhere in the world. stent placement is a superior modality of treatment. However, there will be some situations where operation itself may be difficult due to previous neck surgeries and radiation therapy for any previous neck problems, in such cases stent should be considered.
Carotid surgery generally takes approximately 3 hours and sometimes can be done with local anesthetic medicine while the patient is awake and generally patient can be discharged in 2 days time.
Completed operation appearance of carotid bifurcation with vein patch repair
Sometimes people who did not have any mini-stroke (TIA) symptoms, but have a serious predisposition to these problems with a stroke risk in their family, if their carotid arteries are narrowed more than 50 to 70 % they should see a specialist to discuss whether this operation will benefit them.
