The carotid arteries, together with the vertebral arteries, are responsible for carrying blood to the brain. Their alterations reduce the amount of blood reaching the organ, with all the consequences that this entails. Nowadays, cerebral vascular diseases are one of the main causes of disability. For this reason, their study and prevention is fundamental.
Where is the carotid artery located and what is its function?
The carotid artery is the main artery that irrigates the brain, and its function is to supply arterial blood to this organ. There are two carotid arteries (right and left). Both arise from the aorta inside the thorax (aortic arch) and run along the side of the neck (protected by the sternocleidomastoid muscle). Up to this point they are known as common carotid arteries. At the level of the jaw, they bifurcate into two branches: the internal carotid, which irrigates the brain, and the external carotid, which irrigates part of the face and facial muscles.
What kind of disorders can it suffer from and how can they be detected?
Like other arteries, the carotid artery can suffer from different diseases. The most common condition is stenosis or narrowing. It usually appears after years of smoking, diabetes mellitus, high blood pressure or high cholesterol. The main risk of suffering a carotid stenosis is that there is a deficit of arterial supply to the brain in the form of cerebral embolization, due to the detachment of the atheroma plaque that produces the stenosis, or due to a decrease in blood flow in the brain, known as cerebral vascular accident (stroke or TIA).
The most reliable and safe way to detect carotid stenosis is by means of a Doppler ultrasound study. It is a non-invasive test that is performed on an outpatient basis in the same office of the Angiologist and Vascular Surgeon. It makes it possible to measure the degree of stenosis and the characteristics of the atheroma plaque as well as its evolution, and to determine the most appropriate treatment in each case.
In which cases should surgery be used?
Given the risk of a deficit of arterial supply to the brain, when carotid stenosis is detected, treatment should be initiated to control the risk factors and prevent its progression. Surgical repair is usually indicated when the stenosis exceeds 70% narrowing of the carotid lumen, both in asymptomatic cases and in those with symptoms (patients who have already suffered a stroke or TIA due to stenosis).
What does the surgical intervention consist of?
The surgical procedure indicated in most cases of carotid stenosis is carotid endarterectomy. This procedure is performed under general anesthesia (with the patient asleep). An incision is made on the side of the neck, controlling the carotid artery at its bifurcation. A longitudinal opening of the artery is made, removing the atheroma plaque causing the stenosis and cleaning the artery bed. This opening is closed with a prosthesis or patch to prevent further stenosis in the future. In some cases a system is used to prevent the arterial flow to the brain from decreasing while we manipulate the artery, which is called Shunt.
The procedure lasts approximately 90 minutes, and after the intervention the patient is awakened in the operating room. The patient will spend the first 24 hours in an intensive care unit for immediate postoperative control.
There is another carotid revascularization technique: the carotid stent. Although it is a less aggressive technique (there is no need to make an incision in the neck, as it is placed by puncture of another artery, usually in the groin), its results are worse and it is reserved for those cases in which surgery may be more complex.
Are there any risks?
The procedure is delicate and there are risks, but it is very important to point out that the risks of suffering complications are much greater when the procedure is not used. In addition to the usual risks of any other intervention (hematoma, infection), the main risk of this operation is that there may be a deficit of arterial supply to the brain. However, despite being a delicate procedure, the results of carotid endarterectomy are very good.
How long will it take for the patient to recover completely?
After carotid surgery, the patient can return home 3 to 4 days after the operation. After 24 hours the patient will be able to walk around the hospital and follow a normal oral diet, and at home he/she will be able to progressively resume normal physical activities. Although each case is different, it is usual that after 2 weeks you can return to normal life.