Carotid stenosis is a condition characterized by the narrowing of the carotid arteries, which supply blood to the brain. Surgical treatment for carotid stenosis is primarily aimed at reducing the risk of stroke by opening the narrowed artery. The two main surgical options for carotid stenosis are:
Carotid endarterectomy is a surgical procedure that involves the removal of the built-up plaque from the inner lining of the carotid artery. CEA is considered the gold standard for treating carotid stenosis and is often recommended for patients with significant narrowing of the carotid artery, especially if they have had symptoms of a transient ischemic attack (TIA) or stroke, The procedure removes the source of tiny clots or debris which can fly off the brain from the plaque. Here’s how its typically done:
The patient is placed either general or local anaesthesia with sedation. An incision is made on the side of the neck over the affected carotid artery. The carotid artery is then clamped above and below the diseased section and opened up to remove the plaque build-up, restoring proper blood flow. The artery is then closed back up by suturing a thin panel
(sheet) of biological tissue to prevent re-narrowing.
Carotid artery stenting is a minimally invasive procedure that involves the placement of a stent (a small, mesh-like tube) within the narrowed carotid artery to widen it and improve blood flow. Here’s how CAS is typically performed:
The patient is given local anaesthesia and mild sedation to keep them comfortable during the procedure. Catheter and wire are placed into the Artery at the top of the leg through a needle puncture. Using X-ray guidance, a stent is passed up and deployed within the narrowed portion of the carotid artery, expanding the artery and opening up the diseased segment. After the stent is in place, the catheter is removed, and the artery puncture is closed.
CAS may be recommended for patients who are considered high-risk for traditional carotid endarterectomy, such as those with significant comorbidities. The choice between CEA and CAS depends on various factors, including the patient’s overall health, the extent of carotid stenosis, and individual considerations. The decision is often made through careful evaluation by a vascular surgeon or a team of specialists. Treating carotid stenosis is crucial in reducing the risk of stroke.
Surgical treatment for a Carotid Body Tumour (CBT), also known as a carotid body paraganglioma, is the primary approach to manage this rare type of tumour. CBTs originate from the carotid body, a small cluster of cells located near the carotid artery in the neck. Surgical options for CBT treatment include:
The primary surgical approach for CBTs is complete surgical resection, which involves removing the tumour and any involved surrounding tissue leaving the carotid artery intact.
In some cases, the tumour may be tightly adhered to the carotid artery or its branches. In such situations, the surgeon may need to remove the tumour and the carotid artery together and perform carotid artery reconstruction. This involves repairing or reconstructing the carotid artery, which may include using a graft or patch to maintain proper blood flow.
In some cases, especially when the tumour is large or highly vascular, the patient may undergo preoperative embolisation. During this procedure, a radiologist injects materials into the blood vessels supplying the tumour to reduce blood flow to the tumour. This can help make the surgical removal safer by minimising bleeding during the procedure.
The choice of surgical technique depends on various factors, including the size, location, and extent of the tumour, as well as the patient’s overall health. Complete resection of the tumour is the primary goal, and preserving the carotid artery and its function is essential.
Carotid Artery Dissection is a condition in which a tear or injury occurs in the carotid artery’s inner lining, which leads to the separation of the inner layers of the artery from each other creating a false channel through which blood then flows. It can lead to blood clot formation stroke, or other neurological complications.
Carotid dissection is a condition that requires a multidisciplinary team of healthcare professionals, including neurologists, vascular surgeons, and interventional radiologists, to provide the best care for the patient. Early diagnosis and prompt intervention are critical to prevent further complications and minimise the risk of stroke. The patients are typically
given anticoagulation (blood thinners) tablets and progress monitored closely.
Surgical treatment for Carotid Artery Dissection is typically reserved for specific cases with severe complications or when medical management is ineffective. Surgical interventions include carotid stenting, thrombectomy, carotid artery bypass.
The choice of surgical intervention for CAD depends on various factors, including the extent of the dissection, the patient&its neurological symptoms, and the presence of complications such as clot formation or pseudoaneurysm. It is crucial to make these decisions in consultation with a vascular surgeon or interventional radiologist, who can assess the individual case and recommend the most appropriate treatment approach
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