Carotid endarterectomy

Question 1

What are the indications for carotid endarterectomy over carotid artery stenting?

Answer 1

Ipsilateral TIA or stroke
Surgically accessible artery lesion
No previous endarterectomy
No contraindications to revascularisation such as:
* less than 50% stenosis
* severe comorbidity due to other surgical or medical illness
* disabling stroke
* near-occlusion - patients with total occlusion cannot have revascularisation

Question 2

What are the complications of carotic endarterectomy?

Answer 2

• MI
• Perioperative stroke
• Bleeding
• Cervical haematoma
• Nerve injury - hypoglossal nerve, recurrent laryngeal (vagus nerve), and marginal mandibular branch of facial nerve
• Infection
• Carotid restenosis
• Cerebral hyperprfusion syndrome - due to loss of autoregulation that imapirs the ability of the brain to accommodate to restored blood flow -> headache, seizure, stroke
• Restenosis - 2-10% at 5yrs
• Baroreceptor damage

Question 3

Describe the incision site for carotid endarterectomy.

Answer 3

Longitudinal along the anterior border of the SCM or transverse in a skin crease at the carotid bulb

Question 4

What happens during the carotid endarterectomy procedure?

Answer 4

• GA usually given although LA can be used
• Patient is systematically anticoagulated with heparin which is reversed at the end of the procedure
• Incision is made and plaque is removed
• Usually patch closure is used
• Patient is monitored with systolic targets between 100 and 150mmHg

Question 5

What is the perioperatiev mortality with carotid endarterectomy?

Answer 5

< 0.5 to 3%

Question 6

What is shown?

Answer 6

Carotid endarterectomy scar

NB: types of scars: normal fine line, keloids (scar keeps growing after wound has healed), hypertrophic (xs collagen but do not extend past original wound), pitted/sunken (acne), scar contractures(burns)