Carotid Artery Stenosis Surgery in Michigan
CAROTID ARTERY STENOSIS SURGERY
Carotid disease or carotid stenosis is a narrowing in the carotid artery. The cause of carotid stenosis is atherosclerosis. Atherosclerosis is caused by platelets, cholesterol and smooth muscle cells accumulating in the vessel wall. We call these accumulations plaques.
A narrowing of the carotid artery (carotid stenosis) can be treated by the vascular surgeon in 3 ways:
- Open surgical treatment (carotid endarterectomy)
- Endovascular treatment (carotid stent placement)
- hybrid treatment (combination of surgery and stent placement)
Which treatment is needed depends on several factors, such as:
- localization
- severity and composition of the narrowing
- co-morbidity (the simultaneous occurrence of two or more physical or psychological conditions or disorders) of the patient
- (absence of) specific complaints.
Carotid endarterectomy (open surgery treatment for Carotid Artery Stenosis)
This means cleaning of the carotid artery. After clamping, the vascular surgeon opens the carotid artery by making a longitudinal incision (cut). Then he removes the plague with the help of fine instruments. A smooth inner surface is left behind. In order to then close the carotid artery again, the vascular surgeon stitches a piece of plastic or own vein (for example from the patient’s leg) into the blood vessel as a dilation patch. This means that the blood vessel is closed again and blood circulation can be restored.
Carotid stent placement (minimally invasive treatment For carotid Artery Stenosis)
An endovascular treatment is the placement of a stent in the carotid artery to stretch open the narrowing.
Before the stent can be placed, the blood vessels are visualized via X-rays and contrast fluid. The procedure therefore takes place on a special table in an angiography room where examinations and treatments with radiation are performed.
The procedure
- The vascular surgeon punctures the femoral artery. In patients who stay awake, the groin is locally anesthetized.
- The vascular surgeon moves the stent from the groin all the way up into the carotid artery. The stent is placed in the carotid artery to stretch open the narrowing. The permanent placement of the stent keeps the artery open and prevents clots from entering the brain.
- During the procedure, brain activity is registered in various ways (directly and indirectly). In most cases, the brain is also protected by inserting a proximal protection system.
Hybrid Treatment For carotid Artery Stenosis
A hybrid treatment is the combination of an open surgical treatment with the placement of a stent. We opt for a hybrid treatment when:
- A narrowing of the artery in the neck is associated with a narrowing of the origin of the common carotid artery.
- There is just a narrowing of the origin of the common carotid artery.
Since a narrowing of the origin of the common carotid artery is behind the sternum, treatment with a stent from the groin is dangerous for loosening clots.
Open surgical treatment of this narrowing is complex because the sternum must be opened and the aortic arch clamped. That is why a hybrid technique is chosen for this condition.
The procedure For Hybrid Treatment of Carotid Artery Stenosis
- The vascular surgeon exposes the carotid artery in the neck.
- The carotid artery is punctured down to place a stent in the narrowing at the origin of the common carotid artery.
- The wound is closed in layers and a tube is left for the wound fluid. The vascular surgeon usually removes the tube on the first or second day after the procedure.
- During the procedure, brain activity is registered in various ways (directly and indirectly).