The major blood supply to the brain is supplied by the carotid arteries, which are located on either side of the neck. An artery is normally smooth, allowing blood to flow freely. Arteries may become blocked by atherosclerosis or "hardening of the arteries". You may or may not have any symptoms. Your doctor or health care provider may listen to your neck and hear a "bruit", which is due to turbulent blood flow. Ulcers may also form inside the artery. These ulcers have a rough surface which may cause particles of atherosclerosis or blood clots to break loose into the circulation to the eye or brain. These may cause a TIA (mini stroke), or stroke. We as a team are able to diagnose, evaluate, and treat carotid artery disease.
Transient Ischemic Attack (TIA) or "Mini Stroke"
Signs and Symptoms of TIA
Cerebral Vascular Accident (CVA) or Stroke
Signs and Symptoms of a CVA
Non Invasive Testing
Ultrasound - This type of test uses ultrasound to send high frequency sound waves into the artery which are reflected by moving red blood cells. The vascular technician will place a hand held transducer (probe) on your skin with some gel to perform the test. This test takes about fifteen minutes to complete.
Magnetic Resonance Angiography (MRA) - This test is often used to check for blockages of the arteries in your neck. It uses a large scanner with a powerful magnetic field to produce images based primarily on the water content of the body's fluids, organs, and tissues. It does not use needles or dye, and it is painless. The test takes about thirty to sixty minutes and requires you to lie very still in a noisy tube-like machine. Let you doctor know if you are claustrophobic (cannot stand to be in small spaces) before taking the test. This test cannot be done on people who have metal implants, such as metal plates, pacemakers, orthopedic screws, or cerebral aneurysm clips. It is okay if you have fillings in your teeth, however you must remove any jewelry or watches before the test.
Invasive Arterial Testing - Angiogram
You will be required not to eat solid foods eight hours before, and will need to stop liquids three hours before the angiogram. You will receive specific instructions regarding your medications, insulin and blood thinners from your doctor or nurse before the test.
You will not be able to drive for one day following the procedure. Therefore, you will need to make arrangements for someone to drive you home.
If you are a diabetic please check your fingerstick the morning of your procedure.
For angiograms, an intravenous catheter is inserted into a vein in your arm and you may be given intravenous fluids and/or medications to help you relax. The femoral artery in your groin is most often used to insert a catheter in which to inject dye; however the artery in your inner elbow or armpit may also be used. The area is first shaven and then numbed with a local anesthetic.
A catheter is inserted into the artery and dye is injected and then x-rays are taken. You will feel a warm sensation in your body as the dye is injected. When the catheter is removed, the physician will apply pressure to the insertion site for approximately fifteen minutes. The procedure takes one to one and a half hours to complete. After the procedure you will need to be on bed rest with the affected leg or arm straight for four to six hours. This is to prevent any bleeding at the puncture site.
This whole procedure takes approximately two to three hours. If you need to have any other testing we will try to schedule it the same day. If you are to be admitted the day before your surgery the above tests will be performed when you are admitted.
For same day surgery the hospital will notify you the day before your surgery after 2:00pm to tell you what time to report to the hospital. If your surgery is on a Monday you will be notified the Friday before your surgery.
You will be admitted on the Vascular Surgery service under the care of the Vascular Surgeons. Your referring physician and any other medical specialist will be notified of your admission and surgery dates. If an angiogram is ordered on the day of admission, you should report to the specified area at the instructed time. Otherwise, you will receive a phone call from the Admitting Office with instructions for your arrival. If you do not receive a phone call by 12:00 noon, please contact our office.
If you are to be admitted the day of surgery, you will need to have pre-admission testing prior to your scheduled surgery. At pre-admisson testing you will meet with an anesthesiologist, and nurse. You will have blood work, urine testing, EKG, and a chest x-ray. This whole procedure takes approximately two to three hours. I you need to have a MRA or any other tests we will try to schedule them the same day.
The hospital will notify you the day before your surgery after 2:00pm to tell you what time to report to the hospital. If your surgery is on a Monday, you will be notified the Friday before your surgery.
TREATMENT OF CAROTID ARTERY DISEASE
Risk Factor Modification
It is important to try and eliminate or minimize the risk factors that you can control, such as smoking, obesity, diabetes, and your activity level.
CAROTID ARTERY STENTING
Carotid stenting is generally considered for patients with recurrence of stenosis after previous carotid surgery, previous neck surgery, and/or radiation to the neck region.
The procedure is quite similar to the angiogram except for the following, a small catheter with a balloon is inflated and pushes the plaque against the inner wall of the artery making room for more blood flow. Then a stent is left in place to keep the artery dilated. The balloon is deflated and the catheter is removed. Dye is then injected and x-ray pictures are taken to make sure the artery has opened adequately. You will stay overnight in the hospital.
An antiplatelet agent is usually given prior to the procedure and for some time after, 1 - 3 months or longer. These are used to reduce the risk of platelet aggregation (clumping) and thrombus (clot) formation. Plavix and aspirin are common antiplatelet agents that are generally prescribed before and/or your stenting.
What can I expect before surgery?
What can I expect during surgery?
You will have sterile drapes over your face and an oxygen mask around your mouth. After your neck is numbed, a small incision about four inches will be made below the level of the jaw. Once the carotid arteries are exposed, clamps are placed above and below where the blockage or plaque is located. The artery is then opened and the plaque is carefully removed. The artery is then stitched closed as is the muscle in your neck. The skin is closed with skin staples, and a bandage is applied over the area. Some patients also have a small bulb drainage device inserted at the bottom of their incision to drain away any excess fluid. The entire surgery takes about two hours.
What can I expect after surgery?
After the cervical block wears off you will be able to eat and drink. Your nurse will check your gag reflex to assure that you will be able to swallow without any difficulty and you will be allowed to eat. You will be able to get out of bed the evening of your surgery.
Post-Operative Days 1 and 2
You will be discharged if you are medically and physically ready. The time for discharge is 10:00am
What to Report
It is important to keep your follow up appointments. Ultrasounds of your carotid arteries will be scheduled periodically to monitor the surgery that was done. If any problems occur, do not hesitate to call. There is always someone available to answer your questions.