Carotid Endartectomy and Stenting - Mcglade Vascular Surgery

The Carotid arteries are part of the network of blood vessels that supply the brain. Just behind the jaw bone the main carotid arteries (one on each side) split into two and at this point due to many factors there can be a build-up of fatty plaque causing a narrowing in the artery. This condition is called Carotid artery disease.

The narrowing of the artery caused by plaque can lead to small bits of plaque breaking off and travelling to the brain. These can cause a mini stroke also known as a transient ischaemic attack (TIA) or a major stroke known as a cerebrovascular accident (CVA).

The tighter the narrowing the higher risk of a stroke. However, patients who have had a recent TIA are at a very high risk and likely to need treatment for their disease.

Risk Factors

Fatty Plaque is caused by a number of factors. These include:

Initial Consult with Dr McGlade

Dr McGlade is highly skilled and experienced in this subspecialty of vascular surgery and has been at the forefront of introducing it into both the public and private hospitals on the Sunshine Coast. He has been instrumental in providing education to other medical professionals on this specialty.

Dr McGlade will perform a thorough history and examination and likely order further investigations such as ultrasound or Ct scanning. He will then tailor a treatment plan specific to your needs, this may include admission to hospital for urgent surgery.

The management of carotid disease is complex and should be tailored to the individual patient. Treatment may include medical therapy, conservative or non-operative management, stenting or surgery.

During your consult Dr McGlade will explain to you in detail the risks and benefits of all treatments and the evidence for and against each option. Then together will form an appropriate treatment plan for you.

Surgery

Surgical treatment is aimed at treating the narrowing of the carotid artery and removing the plaque causing it. The two approaches to repair the carotid artery are an endarterectomy and stenting. Both surgical procedures will be discussed with you and which procedure will be a better choice for you.

Carotid Endarterectomy

This surgical procedure is aimed at removing the plaque that has narrowed your carotid artery. By removing this plaque blood flow is restored and prevents plaque dislodging and travelling to your brain. This procedure can be performed with General anaesthetic where you will be asleep or with local anaesthetic and your neck will feel numb with no pain and you remain awake. A small incision is made to the side of your neck and a clamp is placed upon the carotid artery.

Blood will perfuse your brain from the other side carotid artery. If there is not enough blood supply to the brain then a plastic tube called a shunt will need to be used to bypass the operation site temporarily.

Once clamps are in place Dr McGlade will then carefully remove the diseased section of the artery, often a patch is used to widen the artery. This patch may be one of your own veins or a synthetic patch. Both options will be discussed with you in the rooms during your consult. Once the plaque is removed and the artery is repaired the clamps will be removed and the small incision opening in your neck will be closed.

The most appropriate anaesthetic approach will be discussed in your consultation with Dr McGlade where any questions or concerned can be raised.

Carotid Stenting

Carotid stenting is an alternative to endarterectomy and is usually reserved for patient in whom endarterectomy presents an unacceptable risk. This procedure is performed in a state of the art hybrid theatre. With Xray guidance Dr McGlade can precisely locate the narrowing of the carotid artery. A small needle is inserted into the groin and then a fine catheter is introduced up into the carotid artery. A mesh stent is deployed securing the plaque from dislodging and preventing the artery from narrowing again. As there are no nerves within your arteries you will not feel the balloon or stent during this procedure.

Post-operative Care

Post procedure you may be in hospital between 1-3 days, including 1 night in ICU where your progress will be monitored and Dr McGlade will review you daily. Due to the small incision minimal discomfort is expected.

Once back at home it is recommended to limit physical activities for several weeks and avoid driving. Once the several weeks has passed driving and regular activities may resume as usual.

If any changes such as swelling, headaches, changes in body or brain function are noticed then you should present to your local Emergency department.

Treatments

Meet Our Doctor

Dr Daniel McGlade

Endovascular & Vascular Surgeon
MBBS, FRACS (Vasc)