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Encyclopedia > Carotid endarterectomy
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Carotid entarterectomy is a surgical procedure used to correct carotid stenosis (obstruction of the carotid artery by atheroma), used particularly when this causes medical problems, such as transient ischemic attacks (TIAs) or cerebrovascular accidents (CVAs, strokes). Endarterectomy is the removal of material on the inside (end-) of an artery. A typical modern surgery operation For other meanings of the word, see Surgery (disambiguation) Surgery (from the Greek cheirourgia - lit. ... The carotid artery is a major artery of the head and neck. ... An atheroma (plural: atheromata) is an unhealthy tissue growth which develops within the walls of arteries over time. ... Transient ischemic attacks (TIA) are caused by temporary disturbance of blood supply to a restricted area of brain and cause recurrent and brief (less than 24 hours) neurologic dysfunctions. ... A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes) or other causes. ... Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of fatty deposits. ... Section of an artery An artery or arterial is also a class of highway. ...

Contents


Procedure

Many surgeons lay a temporary shunt to ensure blood supply to the brain during the procedure. Some recommend neuromonitoring with electroencephalography (EEG) throughout the procedure. A shunt in general is a sort of relief valve, or diverter. ... In the anatomy of animals, the brain, or encephalon, is the higher, supervisory center of the nervous system. ... Neuromonitoring, or Intraoperative Neurological Monitoring (IONM) or just simply Intraoperative Monitoring (IOM) is the practice of recording nerve signals and brainwaves during surgeries to reduce the risk of significant neuronal damage. ... Jump to: navigation, search Electroencephalography is the neurophysiologic measurement of the electrical activity of the brain by recording from electrodes placed on the scalp, or in the special cases on the cortex. ...


The internal, common and external carotid arteries are clamped, the lumen of the internal carotid artery is opened, and the atheromatous plaque substance removed. The artery is closed, hemostasis achieved, and the overlying layers closed.


Indications

Carotid stenosis is diagnosed with ultrasound doppler studies of the neck arteries or magnetic resonance arteriography (MRA). Stenosis of >70% of the carotid lumen is generally deemed significant. Jump to: navigation, search Medical ultrasonography is an ultrasound-based diagnostic imaging technique used to visualize internal organs, their size, structure and their pathological lesions. ...


Generally, carotid stenosis is not corrected surgically unless it is symptomatic (by causing TIAs or strokes). Endarterectomy itself carries risks (embolisation into the brain with resultant stroke), which outweigh the benefits unless it actually causes symptoms. The circle of Willis typically provides a collateral blood supply. Symptoms have to affect the other side of the body; if they do not, they may not be caused by the stenosis, and repairing it will be of minimal benefit. In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through the circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... Circle of Willis in the human brain. ...


Contra-indications

The procedure cannot be performed in case of:

  • Complete internal carotid artery obstruction (because the intraluminal thrombus then extends too far downstream , well into the intracranial portion of the artery,for endarterectomy to be successful).
  • Previous stroke on the homolateral side with heavy sequelae because there is no point in preventing what has already happened.
  • Patient deemed unfit for the operation by the anaesthisiologist.

Complications

About 3% of patients will suffer neurological complications as a result of the procedure. Hemorrhage of the wound bed is potentially life-threatening, as swelling of the neck due to hematoma could compress the trachea. Neuropraxy of the hypoglossal nerve occurs rarely. Hemorrhage (alternate spelling is Haemorrhage) is the medical term referring to the presence of blood in the interstitial tissues. ... Hematoma on an elbow, nine days after a blood sample was taken A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage. ... The trachea (IPA /treikiÉ™/), or windpipe, is a tube extending from the larynx to the bronchi in mammals, and from the pharynx to the syrinx in birds, carrying air to the lungs. ... The hypoglossal nerve is the twelfth cranial nerve. ...


Reference

  • Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ, Caplan LR, Kresowik TF, Matchar DB, Toole JF, Easton JD, Adams HP Jr, Brass LM, Hobson RW 2nd, Brott TG, Sternau L. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Circulation 1998;97:501-9. PMID 9490248.

External link

  • Carotid endarterectomy (Baylor College of Medicine)

  Results from FactBites:
 
Dr. Koop - Carotid Endarterectomy- Health Encyclopedia and Reference (371 words)
Carotid endarterectomy is a surgical procedure in which a stenosis (narrowing) or ulceration of an atherosclerotic plaque in the carotid artery is removed.
When atherosclerosis has narrowed the carotid artery (one of the arteries supplying blood to the brain), carotid endarterectomy may reduce the risk of stroke.
Based on current knowledge, carotid endarterectomy plus optimal medical treatment is highly effective in preventing stroke and death in symptomatic patients with carotid stenoses greater than 70 percent.
Carotid Endarterectomy (1201 words)
Carotid endarterectomy has now been shown to be effective in preventing subsequent ipsilateral strokes in patients with symptomatic severely stenotic (less than or equal to 70%) lesions at the origin of the internal carotid artery.(ref 1) Efficacy is achieved only if surgical morbidity is sufficiently low.
Furthermore, endarterectomy is under study and may be considered in patients with hemodynamically significant asymptomatic atherosclerotic lesions at the origin of the internal carotid artery.
Carotid noninvasive studies are divided into studies that assess flow and vascular morphology at the bifurcation of the common carotid artery (i.e.
  More results at FactBites »

 
 

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