Our Summary

This research paper discusses problems and solutions related to a surgical procedure called carotid endarterectomy in Russia. It’s a procedure used to prevent strokes by removing blockages from the carotid arteries in the neck. The paper touches on several points:

  1. A program has been developed to decide the best approach to treat patients with blockages in both the heart and neck arteries.
  2. Studies using computer models, genetics, and examination of blockages that reoccur after surgery have shown that the traditional method of carotid endarterectomy, which involves patching the area after removal of the blockage, is not safe.
  3. A new technique has been developed that rearranges the position of an artery in the neck to avoid damage during repeat surgeries.
  4. The paper notes that this surgery is risky for patients over 75 years old.
  5. Performing emergency carotid endarterectomies immediately after a stroke is not safe because it can lead to many unfavorable heart-related events.
  6. Finally, the researchers have developed three new ways to perform the surgery that allow for preservation of a small body of cells in the neck called the carotid glomus.

FAQs

  1. What is the new program for managing patients with simultaneous atherosclerotic lesions of the coronary and carotid arteries in Russia?
  2. Why is the classic carotid endarterectomy with plasty of the reconstruction zone considered unsafe?
  3. What are the newly developed types of carotid endarterectomy with carotid glomus preservation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about carotid endarterectomy is to follow all post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding activities that could put stress on the surgical site. It is important to follow these recommendations to ensure proper healing and reduce the risk of complications.

Suitable For

Patients who are typically recommended for carotid endarterectomy include those with significant carotid artery stenosis who are at high risk for stroke. This includes patients with symptoms of transient ischemic attacks (TIAs) or minor strokes, as well as asymptomatic patients with severe carotid artery narrowing. However, it is important to consider each patient’s individual risk factors and overall health status when determining the appropriateness of carotid endarterectomy. Additionally, certain patients with specific conditions, such as coronary artery disease or advanced age, may require additional evaluation and consideration before undergoing the procedure.

Timeline

Before Carotid Endarterectomy:

  • Patient undergoes a thorough evaluation by a vascular surgeon to determine the necessity of the procedure
  • Patient may undergo imaging tests such as carotid ultrasound or angiography to assess the extent of blockage in the carotid artery
  • Patient may need to undergo pre-operative tests such as blood work, electrocardiogram, and possibly a cardiac stress test
  • Patient is counseled on the risks and benefits of the procedure and informed consent is obtained

After Carotid Endarterectomy:

  • Patient is monitored closely in the hospital for any complications such as bleeding, infection, or stroke
  • Patient may need to stay in the hospital for a few days post-surgery for observation and recovery
  • Patient may be prescribed medications to prevent blood clots and manage pain
  • Patient will have follow-up appointments with their vascular surgeon to monitor their recovery and assess the success of the procedure
  • Patient may need to make lifestyle changes such as quitting smoking, eating a healthy diet, and exercising regularly to reduce the risk of future blockages in the carotid artery.

What to Ask Your Doctor

  1. What are the potential risks and complications of carotid endarterectomy?
  2. How long is the recovery period after the surgery?
  3. What are the alternatives to carotid endarterectomy?
  4. How successful is carotid endarterectomy in preventing strokes?
  5. What is the likelihood of restenosis after the procedure?
  6. Are there any specific lifestyle changes or medications that I should consider post-surgery?
  7. How experienced are you in performing carotid endarterectomy procedures?
  8. Will I need any follow-up appointments or tests after the surgery?
  9. What should I do if I experience any symptoms or complications after the procedure?
  10. Are there any specific factors or conditions that may make me a better or worse candidate for carotid endarterectomy?

Reference

Authors: Belov YV, Kazantsev AN, Kravchuk VN, Vinogradov RA, Korotkikh AV, Shmatov DV, Chernykh KP, Zakeryaev AB, Sukhoruchkin PV, Matusevich VV, Yu Lider R, Kazantseva EG, Zakharova CL, Sh Bagdavadze G, Zharova AS, Artyukhov SV, Lutsenko VA, Sultanov RV. Journal: Curr Probl Cardiol. 2022 Sep;47(9):101272. doi: 10.1016/j.cpcardiol.2022.101272. Epub 2022 May 27. PMID: 35644499