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Carotid endarterectomy in Assuta
This operation, which is used for the purpose of prevention of stroke or transient ischemic attack (mini-stroke) in people with carotid artery disease.
This condition is called atherosclerosis, or stenosis of the carotid artery. Within these layers are formed atherosclerotic, narrowing the lumen of blood vessels, worsening cerebral circulation.
Layering consist of fat, cholesterol, calcium and other substances circulating in the blood. As time passes, they harden and narrow the arteries, restricting the flow of oxygenated blood to the brain, it can cause a stroke.
The cause of atherosclerosis may be the aging process, as well as several other factors:
- diet rich in fats;
- hypertonic disease;
- smoking habit.
If the blood flow through the carotid arteries is blocked or restricted, the two states developing:
- Ischemic stroke - occurs when a complete blockage of the arteries and restriction of blood flow to the brain.
- Embolic stroke - a consequence of the next state. Thrombus formed on the rough surface of the carotid artery, and then breaks off, blocking one or more blood vessels in the brain.
A number of facts about a stroke:
- Blocking blood vessel is the most frequent cause of this condition, it accounted for 80%.
- After cardiovascular diseases and cancer stroke ranks third as a cause of death.
- Stroke - one of the main causes of disability in adults.
The procedure has a 40-year history, was first described in the mid-1950s. To it began to address how to measure the prevention of stroke in the 60 and 70 years. Endarterectomies numbers peaked in the mid-1980s, when it started a study aimed at identifying specific groups of people with the disease of the carotid artery, for which this operation gave the real benefits.
Indications for carotid endarterectomy and contraindications
Two clinical trials supported by the National Institute of Neurological Disorders and Stroke defined indications for surgery.
Carotid endarterectomy is recommended:
- People who have suffered a stroke.
- Patients with warning signs of stroke.
- In marked stenosis - from 70 to 99%.
Status of the carotid arteries is classified to determine whether surgery is needed. One of the scales identifies three categories:
- Slight stenosis - 0-49%.
- Moderate - 50- 69%.
- Heavy - 70- 99%.
Surgery is not recommended for minor stenosis. By turning operation at moderate and severe vasoconstriction. Carotid endarterectomy does not make sense to carry out in case of full lock.
In severe stenosis surgery reduces the 2-year risk of stroke by more than 80%.
With moderate - operation reduces the 5-year risk of stroke by 6.5%. For people with minor stenosis benefits of the procedure do not outweigh the risks.
According to the results of another study, patients with severe stenosis (60-99%) and symptoms of the 5-year risk of stroke has decreased by half.
Contraindications for carotid endarterectomy:
- Ischemic attacks are the result of constriction of blood vessels in the back of the head instead of carotid stenosis.
- A severe form of coronary artery disease.
- High blood pressure that is not controlled with medication.
- Atherosclerosis in many places in the body.
- Heart failure.
- Renal insufficiency.
The cost of carotid endarterectomy
The cost of diagnostic tests, surgery and follow-up care is about 30 -40 000 $. For more detailed information please fill out the request form on the website.
Diagnosis of the disease of the carotid artery in the Assuta
Most often the diagnosis is made when a person has symptoms of a stroke occur. However, the disease can be detected during the tests carried out for other reasons. This condition is called asymptomatic stenosis. Stroke patient is directed to brain imaging. Several methods can be used to study the carotid arteries:
- Duplex scanning - ultrasonic waves are used for imaging blood vessels and measurement of blood flow through them.
- CT produces a detailed picture of the inside of the body using X-ray capabilities.
- CT angiography involves the use of a contrast agent and CT capacity to produce detailed images of the carotid arteries.
- MR angiography - uses magnetic field and radio waves to create pictures of the arteries and blood flow in them.
Usually first perform ultrasound scans that check the presence of stenosis and to determine the need for surgery. If it is determined that the arteries are narrowed, further tests are conducted - CTA or MRA.
Preparation for carotid endarterectomy in Assuta
Surgery is preceded by a thorough preoperative evaluation. The patient undergoes a physical examination, the doctor conducts medical history, ask questions about:
- receiving painkillers and related potential problems and side effects;
- the presence of allergies.
It is important to tell the surgeon and cardiologist about any change in the health condition, including the symptoms of a cold or flu. Any infection can affect recovery.
Before surgery, you may need to undergo an electrocardiogram, blood tests and urine tests, chest x-ray to give the surgeon the latest information on the health status.
The doctor will discuss with the patient preparation for surgery. Can give the following recommendations:
- Quit smoking (if there is such a habit) - Smoking increases the risk of infection, delayed recovery, increases the likelihood of thrombus formation.
- Watch your weight - lose weight if weight - redundant. But as serious physical exertion dangerous to lose weight need to be adhering to the diet.
- Positive thinking - a positive attitude will help cope with the stress caused by the operation, and accelerate recovery.
- Postoperative physical activity. Physical activity helps to restore the body after surgery, but excessive exercise contraindicated. The surgeon will advise in detail on this issue.
Because anesthesia is the safest with an empty stomach, the patient is recommended not to eat or drink after midnight the night before surgery.
Stages carotid endarterectomy of the carotid arteries in Assuta
local anesthetic or general anesthesia may be used. The surgeon and the anesthesiologist will decide what type of anesthetic used. Local anesthesia allows you to control the brain's response with reduced blood supply during the procedure.
Carotid endarterectomy typically takes one to two hours. If there is a blockage both carotid arteries, two separate procedures are met. The second operation is carried out after a few weeks.
The electrodes are connected to the electrocardiograph is attached to the chest, so controlled the rhythm and electrical activity of the heart. Neck purified using an antiseptic to prevent bacteria from entering the wound.
The surgeon performs a small incision, which allows him to gain access to the carotid artery. During the procedure, he decides whether to use a temporary shunt to maintain adequate blood flow to the brain. Shunt - a small plastic tube that is used to withdraw blood from a portion of the carotid artery, where the operation is performed. The decision to use depends on the surgeon's preference and cerebral blood flow monitoring results during surgery.
When a doctor gets access to the carotid artery, it is clamped to stop the blood flow and open up the entire length of the narrowing. The surgeon removes the inner lining of the narrow portion together with layers of (cholesterol deposits). After removal of the stenosis the artery closed with sutures or special patch. Most Israeli surgeons use the patch, but the specific choice depends on the preferences of the doctor. The doctor checks for bleeding after a cut in the neck close. The wound left a small drainage to remove the blood that can accumulate after surgery. It is removed the next day.
Carotid endarterectomy - the postoperative period and recovery
After surgery, the patient is moved to the intensive care unit, where his state of health carefully monitored to ensure that the correction and recovery.
Doctors monitor the breathing and the heart rate of the patient. There may be some discomfort in the neck area due to cut, to eliminate it used painkillers. There may also be numbness around the wound, which disappears after a while.
Most people are able to eat and drink within a few hours after surgery. Patients usually leave the hospital and return home within 48 hours.
If the wound on the neck is closed using sutures are removed after a while. Absorbable materials are also used - thread or special adhesive to the skin. The surgeon will give recommendations for wound care. Usually advice relating to the maintenance of cleanliness, the use of mild soap and warm water.
It may remain a small scar extending from the corner of the jaw to the top of the sternum. Scars the size of 7-10 cm 2-3 months turn into a thin line.
The doctor will tell you when you can start to drive, not to create an emergency situation, for most people - after 2-3 weeks after surgery. If there was a stroke or transient ischemic attack will not be able to drive a car for a month after that.
Generally, patients return to work 3-4 weeks after carotid endarterectomy. The attending physician will give more accurate information when it will be possible to start work activities.
It is recommended to restrict physical activity for a few weeks after surgery. This involves manual labor and sports. If the job involves manual labor, you will need to perform only light work, while the body can not fully recover.
Possible complications of carotid endarterectomy
As with all types of surgery, there are certain risks. There are two main:
- Risk of stroke is about two percent, although rate is higher in people who have suffered a stroke before surgery.
- The risk of death - less than one percent. This may be due to a heart attack or stroke.
Basically strokes that occur after carotid endarterectomy, caused by blocking of the arteries in the brain or bleeding in the early postoperative period. This can happen if the procedure will cause the displacement of a blood clot and block the artery. Assuta Hospital surgical team will do everything possible to prevent it.
Other potential complications of carotid endarterectomy
There is a slight chance of other side effects:
- Pain or numbness in the wound - a temporary phenomenon that eliminate via analgesics.
- Bleeding in the operational area.
- Wound infection - occurs in 1% of people, and can be easily eliminated by antibiotic therapy.
- Nerve damage can cause a hoarse voice, weakness or numbness on one side of the face. This side effect occurs in 4% of people, but as a rule, it is temporary and disappears after 4 weeks.
- Narrowing of the carotid artery re - restenosis, requiring further surgery occurs in 2-4% of people.
Surgeon in Assuta describe in detail about the possible risks associated with carotid endarterectomy before the procedure.
Factors that increase the likelihood of potential complications after surgery include:
- Age - risk increases as you get older.
- No patient suffered a stroke or transient ischemic attack, or how the patient's body recovered after that.
- Whether there is a restriction in the other carotid artery.
- Other pathology - oncology, heart disease, hypertension or diabetes.
Alternative treatment of carotid artery endarterectomy
An alternative procedure is stent or stent. This is a less aggressive technique, because it does not cut in the neck.
Carotid artery stenting is performed under local anesthesia. The doctor inserts a catheter through the femoral artery under X-ray control and leads to the carotid artery. At the end of the catheter is a small balloon that is inflated to approximately 5 mm in place of narrowing the artery, after which the stent - a tubular metal mesh shape. The balloon is removed from the body, leaving the stent, which holds open the artery and restore blood flow.
After the procedure, the patient must lie still for an hour in order to prevent any bleeding from an artery. Require overnight hospitalization, the patient is discharged the next day.
As well as at the endarterectomy, stenting, there are certain risks. The probability of recurrent stroke or death is somewhat higher, especially when the procedure is performed soon after the onset of symptoms. But long-term results of successful stenting do not differ from endarterectomy.
The decision on the choice of procedure will be based on the patient's personal preferences, general state of health, on the evaluation of medical history. One of the main factors - how much time has passed since the last symptom.