Carotid Artery Disease - Procedures, Side effects, Recovery time, Costs and alternatives

Carotid artery disease occurs when fatty deposits or plaques clog the blood ‎vessels that deliver blood to the brain and to the head (carotid arteries). The ‎blockage increases the risk of stroke, a medical emergency that occurs when ‎the blood supply to the brain is interrupted or seriously reduced. This stroke ‎deprives the brain of oxygen. Within short time brain cells begin to die. Stroke ‎is the common cause of death and the leading cause of permanent disability.‎

This disease develops slowly. The first sign that the patient have this ‎condition may be a stroke or transient ischemic attack (TIA). A TIA is a ‎temporary shortage of blood flow to the brain.‎

Treatment of carotid artery disease normally involves a combination ‎medication, some of the lifestyle changes, medication and sometimes surgery.‎The doctor is likely to start with a thorough medical history and a physical ‎examination. This physical exam generally includes listening for a swooshing ‎sound over the carotid artery in the neck, a sound that's characteristic of a ‎narrowed artery. The doctor may then test the physical and mental ‎capabilities such as strength, memory and speech.‎

After that, the doctor may recommend following examinations:‎

• Ultrasound to assess the blood flow and blood pressure in the carotid ‎arteries.‎
• CT scan or MRI scan, to look for evidence of stroke or other abnormalities.‎
• CT or MR angiography, which provides additional images of blood flow in the ‎carotid arteries. ‎

The main goal for treating carotid artery disease is to prevent stroke. Some of ‎the specific treatments depend on the extent of blockage in the carotid ‎arteries.‎ If the blockage is mild to moderate, the doctor may recommend:‎

• Some of the lifestyle changes for slowing the progression of ‎atherosclerosis. Some of the recommendations includes quitting ‎smoking, losing body weight, eating healthy foods, reducing salt and ‎exercising regularly.‎
• Medications to lower cholesterol and controlling blood pressure. The ‎doctor may also recommend taking a aspirin daily or other blood-‎thinning medication to prevent blood clots.‎ If blockage is severe, or if the patient have already had a TIA or stroke, the ‎doctor may recommend removing the blockage from the artery. The options ‎include:‎
• Carotid endarterectomy: The most common treatment for severe ‎carotid artery disease is carotid endarterectomy. The surgeon makes an ‎incision along the front of the neck, the surgeon then opens the affected ‎carotid artery and removes the plaques. The artery is then repaired ‎with either stitches or a graft.‎
• Carotid angioplasty and stenting: If the blockage in the artery is too ‎difficult to reach with carotid endarterectomy or the patient is having ‎other health conditions that make surgery too risky. The patient is ‎given local anaesthesia and a tiny balloon is threaded by catheter to the ‎area of the clog. The balloon is then inflated to widen the artery, and a ‎small wire mesh coil is inserted to keep the artery from narrowing ‎again.‎

The treatment depends on the severity of the patient’s condition, and ‎whether or not the patient is having symptoms from the carotid artery ‎disease, as well as his/ her general health. Firstly, the vascular surgeon may ‎recommend medications and the lifestyle changes mentioned below :

• If the patient have any other medical conditions, he/ she should make sure to ‎follow the physician's instructions to manage them. For example, if the ‎patient have diabetes, he/ she should be sure to monitor and control the ‎blood sugar levels. If having high blood pressure, then the physician may ‎prescribe medications to lower it. If smoking, it should be quit. Cholesterol ‎levels should be checked regularly to be sure they stay within normal limits. ‎The physician may also prescribe some medications, such as statins, to ‎reduce high cholesterol.
• The patient may require surgery if the carotid artery disease is severe or has ‎progressed. Signs of severe disease includes symptoms of TIA, having ‎experienced a stroke in the past, or just having a severely narrowed carotid ‎artery even without symptoms. During the surgery, the vascular surgeon ‎removes the plaque that is blocking the carotid artery.
• ‎This surgery or the procedure is called carotid endarterectomy and can be ‎performed using a local or general anaesthetic, depending upon the situation. ‎Once the anaesthesia has taken affect on the patient, the vascular surgeon ‎makes an incision in the neck and then removes the plaque in the inner lining ‎of the carotid artery. This surgery removes the plaque form the artery and ‎leaves a smooth, wide-open artery. The patient may even be able to leave the ‎hospital as early as the same day or the day after the procedure, depending ‎upon how he/ she feel. Cardio endarterectomy is safe and long lasting when ‎done by a qualified vascular surgeon in the proper circumstances.
• Angioplasty and stenting: This procedure is newly developed to treat carotid ‎artery disease. This procedure is usually performed by using a local ‎anaesthetic. To perform angioplasty and stenting, the vascular surgeon may ‎insert a long, thin tube called a catheter through a small puncture site over a ‎groin artery and guide it through the blood vessels to the carotid artery. The ‎surgeon then takes an X-ray picture, called an angiogram, by injecting ‎contrast dye through the catheter to see the location and details of the ‎obstructing carotid plaque. The surgeon then insert a tiny balloon through the catheter that inflates and ‎deflates, flattening the plaque against the walls of the artery. After that, the ‎surgeon places a tiny metal-mesh tube called a stent in the artery to hold it ‎open. For patients who are having medical conditions that increases the risk ‎of carotid endarterectomy, angioplasty and stenting is a good alternative. It ‎has been approved for patients who are considered to be at high risk for the ‎surgical endarterectomy procedure.‎

Persons who have some of the symptoms or signs of carotid artery disease ‎are eligible for treatment. The condition of the patient sometimes may go ‎unnoticed until it's serious enough to deprive brain of blood, causing a stroke ‎or TIA.‎ Symptoms and signs of a stroke or TIA includes:‎ Sudden numbness or weakness in the limbs or face, often on one side of the ‎body

• Troublein speaking and also in understanding
• Trouble in seeing from eyes
• Dizziness or loss of balance suddenly ‎
• Severe headache with unknown cause

The physician may performs some tests on the patient to check whether he/ ‎she is eligible for the treatment or not.‎

The side effects caused due to medication may be that the blood thinners may cause changes in the clotting time and thus the patient is required to keep himself or herself safe from injuries. The medication may cause headache, nausea, drizziness etc. In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

Some of the post treatment guidelines or precautions to be taken care of are:-‎

• Most of the normal activities can be resumed within 3 to 4 weeks. The ‎patient may have a slight neck ache for about 2 weeks.‎
• The patient may start doing everyday activities as soon as he/ she feel ‎up to it. Help may be needed with meals, taking care of the house.‎
• Driving should be avoided until the incision is healed.‎
• The patient may have some numbness along the jaw and near the ‎earlobe. This is from the incision. Most of the time, this goes away in ‎from 6 to 12 months.‎
• Shower can be taken whenever the patient go to home. It is ok if the ‎surgical tape on the incision gets wet. Soaking or scrubbing or having ‎shower water beat directly on the tape should be avoided. The tape will ‎curl up and fall off after a week.‎
• Incision should be observed every day for any changes. Lotion, cream, ‎or herbal remedies should not be applied on it without asking the ‎health care provider.
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• Until the incision heals wearing turtlenecks or other clothes around the ‎neck should be avoided that rub against the incision.‎
• Carotid artery surgery alone does not cure the cause of the blockage in ‎the arteries. The arteries may become narrow again. To prevent this ‎healthy foods should be taken, regularly exercise should be done, ‎smoking should be stopped and stress level should be reduced.‎
• Medicine should be taken to help lower the cholesterol if the doctor ‎prescribes it. If medicines for high blood pressure or diabetes is being ‎taken regularly it should be taken the way as directed by doctor.‎
• The patient may be instructed to take aspirin or a medicine ‎called Plavix. These medicines keep the blood from forming clots in the ‎arteries and in the stent. Should not be stopped taking them without ‎consulting with the doctor.‎

The doctor should be informed if following things happen:‎

• If having a headache, becoming confused, or having numbness or ‎weakness in any part of the body.‎
• If having problems with the eyesight, cannot talk normally, or having ‎trouble in understanding what other people are saying.
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• If cannot move the tongue to the side of the mouth.‎
• Trouble in swallowing.‎
• Chest pain, dizziness, or shortness of breath and that is not going away ‎with rest.‎
• Having chills or a fever over 101°F or a fever that does not go away ‎after taking acetaminophen (Tylenol).‎
• If the incision becomes red or painful, or yellow or green discharge is ‎draining from it.‎
• When legs are swelling.‎

Recovery from angioplasty and stenting does not take much time. The patient ‎is discharged from the hospital in usually 12 to 24 hours after the catheter is ‎removed. Many patients are able to return to work within a few days after ‎this procedure.‎

The treatment cost varies from place to place and hospital to hospital. Carotid ‎Endarterectomy charges start from ‎ INR 600000.‎

No the results are not permanent as there are some risks associated with this ‎surgery or treatment are:

• Strokes and Mini Strokes: People undergoing carotid endarterectomy ‎face a little risk of a stroke. This complication affects only about 1 to 2 ‎percent of people who have not experienced a stroke before surgery. ‎To counter this risk, the surgeon may place a shunt into the patient’s ‎artery during surgery to redirect blood from the surgery site to the ‎brain to ensure that the brain receives adequate blood flow during the ‎procedure. The patient may also be prescribed an anticoagulant ‎medication before surgery to reduce the likelihood of blood clots.‎‎
• Heart Attack: This treatment or surgery can cause a considerable ‎amount of stress on the body, especially the heart. To reduce the risk of ‎a heart attack, the medical team closely monitors the blood pressure ‎and heart rate throughout the procedure and during the recovery in ‎the hospital. If anything irregular is noticed with the heartbeat, the ‎doctor and nurses will take the necessary steps to correct the problem.‎
• Nerve Damage: The carotid arteries run through the areas of the head ‎and neck. This carotid arteries contain highly sensitive nerves which ‎are related to the functioning of the voice box, tongue and the ‎movement of the neck and back. During this surgery, those nerves may ‎be damaged, causing either a temporary or permanent loss of some ‎function in those areas.‎

Some of the alternatives of the treatment or precautions to be taken care of ‎are:-‎

• Smoking should be quitted as it can reduce the stroke risk to that of ‎someone who doesn’t smoke within a few years.‎
• Cholesterol and fat in the diet should be limited will reduce the risk of ‎atherosclerosis.‎
• Regular exercise also helps lower blood pressure, increases good ‎cholesterol levels, and also improve heart health.
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• Alcohol consumption should be reduced may improve the heart health.‎
• Keeping a healthy weight can reduce the risk of developing carotid ‎artery disease.‎
• Diabetes and other chronic health conditions should also be managed it ‎is also a great way to reduce your risk of long-term complications, such ‎as carotid artery disease or stroke.‎