What causes carotid artery disease?

There are a number of factors that can put you at increased risk of developing carotid artery disease.

These include:

• Smoking
• High cholesterol
• High blood pressure
• Older age

Carotid artery disease symptoms

Most people with carotid artery disease do not experience any symptoms. However, some people may experience a stroke or a transient ischaemic attack (TIA) as a result of carotid artery disease. A TIA is also known as a ‘mini-stroke’ and has similar symptoms to that of a stroke (including feeling weak or numb, feeling dizzy, drooping of one side of the face, headache and problems with speech or vision) but will only last a few minutes to a few hours. A TIA is often a warning sign for a future major stroke and so should be investigated fully.

Examination and investigations

Before diagnosing carotid artery disease, the doctor will perform an examination and some investigations. During the examination the doctor will listen to the blood flow through the carotid arteries by placing a stethoscope over the neck. They may hear an unusual murmur, known as a carotid or cervical bruit, which indicates turbulent blood flow through the carotid arteries. This can be a good indicator of the presence of fatty deposits in the blood vessels.

Imaging studies are often performed to confirm the presence of carotid artery disease. Such investigations most commonly include an ultrasound, but can also involve digital subtraction (DS) angiography, computed tomography (CT) angiography and magnetic resonance (MR) angiography. These tests can examine the blood flow in the carotid arteries and visualise the narrowing of the carotid arteries.

Carotid artery disease can be treated either with surgery (carotid endarterectomy) or by stenting.

Carotid endarterectomy

Carotid endarterectomy is the most common surgical procedure for carotid artery disease. Surgery involves making an incision in the neck where the carotid artery is, removing the plaque from inside the arteries, and then repairing and closing the artery. This procedure is usually performed under a general anaesthetic.

Carotid endarterectomy, like any operation, carries risks, so surgery is only undertaken if the benefits outweigh the risks of the operation. Dr Shakibaie has performed hundreds of surgical procedures on carotid arteries with excellent results and outcomes. He will advise you on the best management and course to take for your condition during your consultation with him.

Stenting

Stenting is where a small tube is placed inside the carotid artery in order to widen it and allow adequate blood flow through it. The procedure involves a surgeon making a small incision, usually in the groin, and passing a tube through to the carotid arteries in the neck. This is done under x-ray guidance. A wire is then pushed through the tube to the blockage, and another tube with a balloon is pushed over this wire. The balloon is then inflated, opening up the artery, and a stent (small tube) is placed in the area to keep the artery open. This tube stays in place for life.

Although less invasive, stenting carries a slightly higher risk of major complications, such as stroke, so carotid endarterectomy is more routinely performed.  Stenting is usually reserved only for people not suitable for carotid endarterectomy.

Carotid artery surgery instructions

Treatment for carotid artery disease can involve surgery or stenting. There are a number of things you have to do before your treatment and also afterwards to make sure that your recovery goes as well as possible. Following these steps will also make sure that the treatment you have received is as effective as possible.

Before the procedure

• Do not eat or drink for at least 6 hours before your scheduled surgery start time.
• Take your regular medications (unless otherwise instructed) at your normal time with sips of water on the day of surgery.
• If you have any questions or concerns, please do not hesitate to contact Dr Shakibaie’s office.

After the operation

• You will be admitted to the Intensive Care Unit where you will be closely monitored for at least 24 hours.
• You may have a tube (drain) inserted into the surgical site. This is usually removed after 24-48 hours.
• The pain and discomfort over the incision will probably start a few hours after the operation once the local anaesthetic wears off.
• After discharge from the Intensive Care Unit, you will be transferred to one of the hospital wards where you will stay for another day.
• Discharge is usually 2 days after the surgery.

After hospital discharge

• You can resume your normal activities as you recover. However, do not do any intense exercise in the first fortnight post-surgery, as this can elevate the blood pressure which may cause problems.
• Leave the dressing intact 3 days after discharge and then remove.
• Do not shave around the incision site for 10 days.
• It is ok to get the wound wet during showers, but make sure you dry the area thoroughly soon after.
• If you feel any numbness or loss of movement in any of your limbs which does not resolve within 5 minutes, call an ambulance to bring you back to hospital (this is a very rare occurrence).

Follow up

• An ultrasound of your neck will be arranged for approximately 4 weeks post-surgery, followed soon after by an appointment to see Dr Shakibaie.
• If you have not heard from us within two weeks of discharge, please contact Dr Shakibaie’s office on 9310 2300.