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Carotid Artery Disease Guide

What is Carotid Artery Disease?

The carotid arteries are the blood vessels within the neck that carry blood to the brain and other parts of the head. Normal arteries are smooth inside with no obstruction to blood flow. As people age, the blood flow though one or both of the carotid arteries can block due to build up of a fatty substance called plaque. This plaque causes narrowing of the arteries requiring surgical removal. Often blood flow is reduced by 2 to 3 times and in severe cases to a trickle.
A blood clot or a piece of plaque may break off from this narrowed area causing a stroke or transient ischemic attack (TIA). Strokes can cause weakness or numbness of the body and face. Vision and speech can also be affected. A TIA is a stroke from which the patient recovers completely within 24 hours. It is a warning of blockages in the arteries.

Treatment Options

Medication

Medication can be used alone or in conjunction with any of the other treatments. Medication does not eliminate the narrowing of the arteries, but can improve blood flow and/or prevent blood clots.

Stenting

The operation can be done while you are asleep or awake, the doctor will discuss this with you. A stent is expanded into the carotid artery wall This stent will remain in place permanently to keep the artery open.

Open Surgery

In certain complex cases where minimally invasive options aren’t suitable, traditional open surgery remains the most effective and durable treatment. These procedures are performed with precision and care, always guided by the goal of restoring function, relieving symptoms, and achieving the best possible long-term outcomes.

Before the operation

The following tests would have been performed:

  • Chest x-ray
  • Blood tests
  • Electrocardiogram (ECG)
  • Urine test
  • You will be seen by the anesthetist

Medications

You should continue taking your normal medications. Please consult your doctor for advice if you are taking WARFARIN or HORMONE REPLACEMENT.

Belongings and valuables

Please bring your own toiletries and pajamas. Leave any valuables at home.

The day before the procedure

You will be admitted to the ward for bowel preparation. This will involve drinking fluids only and you will also be given an enema. Nothing is to be taken orally from 10 pm at night. You will also be given lung physiotherapy.

Post-Operative Plan

IMMEDIATELY AFTER THE PROCEDURE

Surgery

You will spend one night in the Intensive Care Unit (ICU) before returning to the ward. The nurse looking after you will: • Connect you to a machine that will monitor your heart rate and rhythm • Check your blood pressure often • Shine a torch into your eyes to check your pupil responses • Check your arm and leg movements • Check that the tube in your arm and drain in your neck are working

Stenting

You will spend one night in the High Care Unit where the nursing staff will check the site where the catheter was inserted as well as the pulses in your feet and arms. If your groin was used in the procedure you cannot sit up until instructed to do so. You will urinate often to get rid of the x-ray dye that was injected into your arteries. You will be instructed to drink more fluids to get rid of the dye more easily. Before you leave the hospital, your doctor will instruct you about the pharmaceutical therapy and activity levels following the procedure. It is very important to regularly check the condition of your carotid arteries and your doctor will schedule those check-ups with you.

DIET AND FLUIDS
You may eat and drink as you like.
ACTIVITY
Day One – Post Surgery
• You will continue to be connected to a heart monitor
• The tube will be removed from your arm
• The drain will be removed from your neck You will be asked to spend most of the day in bed, however, if you are well enough you may walk to the toilet.

Day Two
• You can shower and walk freely
• The dressing will be removed from your neck, cleaned and left open

Day Two to Five
• You will be discharged

Information for your use at home

ACTIVITY
You may start your usual activities and drive as you feel able.

WOUND CARE
• Leave the wound uncovered
• Clean the wound with warm water while showering. Pat dry with a clean towel.

FOLLOW UP
An appointment will be made for you to see Dr Tudhope one week after the operation, and six weeks thereafter.

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