Most strokes occur when the blood supply to your brain is interrupted by deposits of plaque in the blood vessels that are caused by atherosclerosis. The two main arteries that bring blood to your brain are the left and right carotid arteries, on either side of your neck. When these arteries become hardened or narrowed by deposits of plaque, which is made from fat and cholesterol, you have a condition called cerebrovascular disease and risk having a stroke.
Some individuals who have cerebrovascular disease do not have any symptoms, but others experience TIAs (Transient Ischemic Attacks) or “mini-strokes.” TIAs are a warning sign, because if are they left untreated, many of these patients will later have a stroke. Initial strokes are fatal in 20 to 30% of individuals, so it is important be aware of the signs and symptoms of a stroke and know what your risk factors are (see below).
Atherosclerosis and cerebrovascular disease may not produce symptoms until more than two-thirds of a blood vessel is occluded (blocked) by plaque. However, the build up of plaque can interfere with smooth blood flow, causing tiny clots to form. Also, pieces of the plaque can break off, releasing emboli into the blood stream. A small clot or embolus in the blood stream can obstruct a blood vessel deeper into the brain, causing a stroke or TIA. Surgery is indicated when well over half of the artery is occluded (blocked), or when you have experienced a TIA. The surgical procedure to clean plaque from the wall of the carotid artery is called a carotid endarterectomy, or CEA. This surgery will improve the smooth flow of blood through your carotid arteries.
There are many risk factors for atherosclerosis. Making changes in your lifestyle or taking medications can reduce your risk.
Risk Factors for Atherosclerosis
Stroke. The symptoms of a stroke vary, depending on the location of the embolus or clot that cuts off blood flow in your brain. They usually involve a loss of motor and sensory abilities in the arms and legs. Often only one side of your body is affected: the side opposite the location of the clot or embolus. You may also experience slurred speech and drooping of one side of the face.
While symptoms of a stroke may heal over time, some deficits may always remain. It is also important to remember that even a first stroke can be fatal. Of those who survive a stroke, half will suffer another stroke.
TIA (Transient Ischemic Attack). Symptoms of a TIA include a short-term numbness or paralysis of an arm, leg, or both on one side of the body. These symptoms are caused by a small clot or embolus to the brain that blocks blood flow. By definition, any motor or sensory loss caused by a TIA will resolve in 24 hours or less. Common temporary symptoms include difficulty speaking or understanding others, loss or blurring of vision in one eye, and loss of strength or numbness in an arm or leg. Usually these symptoms resolve in less than 10 to 20 minutes, and almost always within one hour. Even if all the symptoms resolve, call 000 to be evaluated immediately.
Amaurosis fugax occurs when an embolus or clot travels to the ophthalmic artery and blocks blood flow there. This causes temporary loss of vision in the affected eye. The blindness usually begins in one quadrant of the eye and progresses until all vision is lost. Vision is restored in the same pattern.
Carotid Bruit – even if you have no symptoms, your Dr may detect cerebrovascular disease by the presence of a carotid bruit. This is an abnormal sound heard with a stethoscope placed over the carotid arteries in the neck.
Carotid Duplex Ultrasound – an ultrasound of the arteries in the neck can show the presence of stenosis, or narrowing of the carotid arteries due to the buildup of plaque. This painless test is done in the office while you are awake.
Magnetic Resonance Angiography (MRA) – similar to a conventional MRI, a dye is injected into your vein to ‘light up’ the carotid arteries and create a picture of how they are working from the heart up into the brain
Computed Tomography Angiography (CTA) – a form of CT scan similar to the MRA in that a dye is injected into the veins
There are some non-surgical interventions that can help you manage this disease and lower your risk for TIAs, stroke, and other adverse effects of atherosclerosis. Some of these measures include:
When atherosclerosis has damaged your carotid arteries, it has likely also affected blood supply in other parts of your body, such as your coronary and femoral arteries. Thus you may also be at risk for a heart attack and peripheral vascular disease. Check with your Dr to see if you should have additional screening done.
It is important to be aware of the risks and complications before any surgical procedure. The risks and complications for carotid surgery include: bleeding, infection, numbness or pain around the incisions, risks from anaesthesia, temporary or permanent facial numbness due to nerve damage from the incision, stroke, heart attack
Dr Hagley will tell you how to prepare for your surgery. Be sure to ask any and all questions you may have. On the day of the surgery, do your best to arrive at the hospital on time.
In this procedure, the affected section of the lining of the artery is removed and is left with as smooth an internal surface as possible. During the procedure, the arteries are clamped and a small tube called a shunt may be inserted to reroute the blood to the brain around the section being worked on. The artery is then closed, sometimes with a graft called a ‘patch’.
The procedure is normally carried out under a general anaesthetic and involves making a ~5cm incision on the side of the neck between the ear and the collarbone. It takes around 2 hours, and patients are routinely admitted to the Intensive Care Unit (ICU) overnight for monitoring with a short hospital stay afterwards.
On the day of admission to hospital you will not eat or drink anything for at least 4 hours prior to the procedure. Fast from midnight if you are an early morning case. Pathology tests may be required prior to procedure.
The nurse will take your blood pressure, temperature and pulse in preparation for surgery.
Constipation is very common following a surgery. The anaesthetic used during the operation paralyzes the bowel, which can lead to constipation for up to a week. Strong pain medications also cause the bowel to move more slowly. You may be prescribed medications, as well as prune or apple juice to get your bowels moving.
Pain is common after surgery, especially around an incision site. The pain medication prescribed will help with this pain, which should improve in the days following your surgery. Be sure to stay ahead of the pain and take your pain medication as prescribed. Check with Dr Hagley before using other pain medication in addition to the prescribed pain medication.
Fever: Your temperature can vary after surgery and a low-grade temperature is common. If you have a high temperature or if it is accompanied by chills, vomiting, or flu-like symptoms, Dr Hagley should be notified.
Full recovery takes between two to four weeks after carotid surgery. The speed of recovery will also be affected by your age and general fitness.
Discussions with patients who have undergone a bypass suggest that it can be normal to make a full recovery in about two weeks, however some people take longer and can tire and take several weeks to return to the health state they had prior to the operation. During this time, you should gradually build up your level of activity back to normal. You may resume normal sexual relations as soon as you feel comfortable.
If you have any further questions, please do not hesitate to ask either Dr Hagley, one of his team, or the nurses looking after you on the ward. If any problem arises after surgery contact the Silverton Rooms 3831 4499, your GP, or attend the Mater Private Accident & Emergency Department.
You are advised to return to the Mater Hospital Emergency Department should any of the following happen:
Dr Hagley participates in surgical on-call rosters at both his private and public hospitals.
If you need to speak to Dr Hagley specifically, please contact via the Mater Switchboard.
