A stroke risk reduction surgery

Stroke is one of the very serious problem which causes severe impairment to person, a big financial burden on family and often it is life threatening. Out of the various causes which cause stroke Carotid artery narrowing is one of the main and treatable cause. Carotid arteries are the main blood supply to brain one on each side arising from big vessel Aorta and going on each side of neck under the muscles and there are two vertebral arteries which run in a tiny hole in our spine bone in neck.

Patients who had symptoms of stroke or mini –stroke which include Sudden loss of sensation and/or function in one of the limb, sudden loss of speech or sudden loss of vision in one eye with typical description of curtain coming in front of eye should quickly consult specialist and should have a scan to see how much their Carotid arteries are narrowed along with investigations for other causes the problem.

The scans will clarify what is the status of their carotid arteries, the degree of narrowing and any irregularity in lining and fresh blood clots sitting in that area – all the above findings are very important to know as the situation needs urgent further investigations and management.

When the carotid artery is narrowed more than 50 to 70 per cent and the inside lining is very irregular with fresh blood clots, sometimes clearly seen on various modalities of investigations, there is a very high chance that they will have another serious episode of stroke which can be prevented.

Carotid Endarteriectomy- which is removing the damaged lining inside the carotid artery and repairing the artery is one of the well established treatment for reducing the risk of a life threatening stroke in people who had mini- stroke ( TIA) symptoms. These operations are done by highly Specialized Vascular Surgeons and need a detailed discussion of the need of the procedure, possible outcomes and risks and benefits.

There are no well established, equally effective and durable alternatives when the carotid arteries are severely narrowed. Some specialist proposes inserting a Stent (a metal spring) inside the artery and widen it. Inserting a stent was rigoursly evaluated against Carotid surgery and the research has not shown any where in the world stent placement is a superior modality of treatment.

How ever there will be some situations where operation itself may be difficult due to previous neck surgeries and radiation therapy for any previous neck problems in such cases stent should be considered. Carotid surgery generally takes approximately 3 hours and some times can be done with local anesthetic medicine while the patient awake and generally patients can be discharged in 2 days time.

Some times people who did not had any mini-stroke ( TIA) symptoms, but have a serious predisposition to these problems with a stroke risk in their family, if their carotid arteries are narrowed more than 50 to 70 per cent should see specialist to discuss whether this operation will benefit them. (The writer is MS, FRCS. Vascular Surgeon, Global Hospitals, Hyderabad.)

By Dr Bheem Sangars​