Carotid Artery Disease

Carotid artery disease, also referred to as cerebrovascular disease, affects the vessels leading to the brain. Like the heart, the brain’s cells need a constant supply of oxygen-rich blood. This blood supply is delivered to the brain by the two large carotid arteries in the front of your neck and by two smaller vertebral arteries at the back of your neck. The right and left vertebral arteries come together at the base of the brain to form what is called the basilar artery. When the carotid arteries become blocked and the brain does not get enough oxygen, it can cause a stroke.

Carotid artery disease increases the risk of stroke in 3 ways:

• By fatty deposits called plaque severely narrowing the carotid arteries.
• By a blood clot becoming wedged in a carotid artery already narrowed by plaque.
• By plaque or a clot breaking off from the carotid arteries and blocking a smaller artery in the brain (a cerebral artery).

As traditional surgery is done under a general anesthetic, the surgeon cannot know whether or not the brain is being negatively affected during surgery.

Carotid Endarterectomy under regional anesthesia

Dr. Miguel Gomez, founder at International Robotic Surgery Center for the Heart and Chest performs a minimally invasive procedure called carotid endarterectomy under a local anesthetic so he can continuously monitor his patient’s brain function. Benefits of using a local anesthetic include:

• Less chance of a heart attack
• Patient may feel some pulling or tugging, but no pain
• Throughout the procedure, a patient is awake and able to communicate mental or physical changes

Carotid endarterectomy removes plaque from the carotid artery. It is the third most common kind of cardiovascular surgery in the United States. During the operation, the surgeon peels the plaque away from the carotid artery. Once the plaque is removed from the carotid artery, more oxygen-rich blood can flow through the artery to the brain, reducing the risk of stroke.

Carotid endarterectomy can also help relieve the symptoms of mini strokes, known as transient ischemic attack (TIA). TIAs are episodes of dizziness, tingling, numbness, blurred vision, confusion, or paralysis that can last anywhere from a few minutes to a couple of hours. Studies have shown that a carotid endarterectomy works better than medicines alone in preventing a stroke in people with severe blockages in the carotid arteries.

Another minimally invasive technique used is a carotid stent to repair the artery. The risk is that the stent, a balloon inserted into the artery, can loosen the plaque while being put in place which can result in a blockage. Higher post-surgery stroke rates are reported when the stent is used, but is balanced by a lower risk of heart attack.

A patient should be able to ask his surgeon about his stroke rate in performing a Carotid endarterectomy. This rate; following surgery; should be no higher than 2 to 3 percent. Dr. Miguel Gomez a documented stroke rate of 0.5 percent.

If you think you might be a candidate for “Carotid Endarterectomy” contact our office for an appointment.