Our Summary

This study compared two types of surgery used to treat a narrowing of the internal carotid artery, a condition which can lead to stroke. The two procedures are called carotid endarterectomy with patch angioplasty (p-CEA) and eversion carotid endarterectomy (e-CEA). The researchers looked at 62 patients who were having one of these surgeries and followed them for a month after their procedure.

They found that during the e-CEA surgery, 70% of patients experienced an irregular heart rhythm, known as an arrhythmia. This percentage decreased over time, but was still at 13.3% a month after surgery. For the p-CEA surgery, the proportion of patients with an arrhythmia was lower at all time points.

The results suggest that the e-CEA surgery is associated with a higher risk of arrhythmia. However, the researchers note that more studies are needed to fully understand the implications of these irregular heart rhythms, both immediately after surgery and in the long term.

FAQs

  1. What are the two types of surgery used to treat a narrowing of the internal carotid artery?
  2. What is the risk of arrhythmia in patients undergoing e-CEA surgery?
  3. Are more studies needed to understand the implications of irregular heart rhythms after e-CEA surgery?

Doctor’s Tip

A doctor might advise a patient undergoing carotid endarterectomy to discuss with them the potential risks and benefits of different surgical techniques, such as p-CEA and e-CEA, and to be aware of the possibility of experiencing an arrhythmia after surgery. It is important for patients to be informed and to ask any questions they may have about their procedure to ensure the best possible outcome.

Suitable For

Carotid endarterectomy is typically recommended for patients who have significant narrowing in their carotid artery, which can increase the risk of stroke. Patients who are considered good candidates for carotid endarterectomy are those who have symptoms of carotid artery disease, such as transient ischemic attacks (TIAs) or strokes, as well as those who have asymptomatic carotid artery stenosis but have a high risk of stroke based on other factors such as age, gender, and the degree of stenosis. It is important for patients to discuss their individual risk factors and treatment options with their healthcare provider to determine the most appropriate course of action.

Timeline

  • Before the carotid endarterectomy surgery:
  1. Patient is diagnosed with a narrowing of the internal carotid artery, usually after experiencing symptoms such as stroke or transient ischemic attack (TIA).
  2. Patient undergoes pre-operative evaluations, including imaging tests like ultrasound or angiography to determine the extent of blockage in the artery.
  3. Patient may be put on medications to manage their symptoms and reduce the risk of complications during surgery.
  • During the carotid endarterectomy surgery:
  1. Patient is put under anesthesia.
  2. Surgeon makes an incision in the neck to access the carotid artery.
  3. The blockage in the artery is removed and the artery is repaired using either patch angioplasty (p-CEA) or eversion technique (e-CEA).
  4. Surgery typically lasts 1-2 hours.
  • After the carotid endarterectomy surgery:
  1. Patient is monitored in the recovery room for a few hours before being transferred to a regular hospital room.
  2. Patient may experience some pain and discomfort at the incision site.
  3. Patient is encouraged to walk and resume normal activities gradually.
  4. Patient may need to take medications to prevent blood clots and manage pain.
  5. Patient may need follow-up appointments with their surgeon to monitor their recovery and assess the success of the surgery.
  6. Patient may be advised to make lifestyle changes, such as quitting smoking and maintaining a healthy diet, to reduce the risk of future blockages in the carotid artery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with carotid endarterectomy surgery?
  2. How does the e-CEA procedure differ from the p-CEA procedure in terms of technique and outcomes?
  3. What is the likelihood of experiencing an irregular heart rhythm (arrhythmia) during and after the surgery?
  4. How long does it typically take to recover from carotid endarterectomy surgery?
  5. What are the long-term effects of having an arrhythmia following carotid endarterectomy surgery?
  6. Are there any specific factors that may increase the risk of arrhythmia during the surgery?
  7. What steps will be taken to monitor and manage any arrhythmias that may occur during or after the surgery?
  8. How frequently will follow-up appointments be needed after the surgery to monitor for any complications or irregular heart rhythms?
  9. Are there any alternative treatment options to carotid endarterectomy that may be considered?
  10. What is the success rate of carotid endarterectomy surgery in terms of preventing stroke in the long term?

Reference

Authors: Vukas H, Kadić-Vukas S, Piljić D, Vranić H, Jogunčić A, Đozić E, Kšela J. Journal: Saudi Med J. 2024 Jul;45(7):685-693. doi: 10.15537/smj.2024.45.7.20240245. PMID: 38955440