Operation carotid atherosclerosis assigned when vasoconstriction, discourages enough blood to the brain. The nervous system has high sensitivity to oxygen deficiency. Even poorly marked narrowing of the blood vessels feeding the brain leads to hypoxia, organ tissues, often culminating in death. Surgery is the only way to save the patient's life.
Indications and contraindications
Surgical treatment is indicated for:
- pronounced narrowing of the arterial lumen even if no signs of disease;
- ischemic brain lesions;
- adjourned earlier stroke, after which there is narrowing of the blood vessels by more than half, and symptoms of ischemic brain damage;
- the rapid development of chronic coronary disease, accompanied by disturbances of the central nervous system functions;
- bilateral atherosclerosis;
- simultaneously overlapping gaps of several large vessels.
Despite the availability of direct evidence for the operation, holding the intervention represents a high risk to the patient's life. Removal of plaque in the carotid artery surgically contraindicated in:
- severe respiratory, hepatic, cardiac and renal failure;
- decompensated diabetes;
- impaired consciousness;
- acute stroke;
- long absence of consciousness, coma;
- severe intracranial hemorrhage, necrosis caused by large vessels;
- complete blockage of the carotid arteries, accompanied inoperable lesions of brain tissue.
Preparation and inspection before the
Before you remove atherosclerotic plaques, Provide training, which includes the following steps:
- Rejection of reception of some drugs. 2 weeks before surgery stop taking aspirin, warfarin, and other anticoagulants. This helps to avoid the development of bleeding.
- Examination. To determine indications and contraindications for surgery carried duplex ultrasonic scanning vessels, computed tomography of the brain and neck area, magnetic resonance imaging and angiography. These methods are aimed at determining the localization of atherosclerotic plaques and blood flow in the cerebral vessels.
- Failure of the meal. It starts the night before the procedure. On the day of the operation can not be used even liquid.
course of the operation
Select the method of surgical removal of cholesterol plaques in the carotid arteries depends on many factors, including the availability of the required equipment and the condition of the patient. The most common method is considered to endarterectomy.
carotid endarterectomy
This is a common operation to eliminate atherosclerosis in which the vessel is cleared of pathological content. Surgery involves the following steps:
- Formulation of general anesthesia.
- Providing access to the damaged arteries. Incision behind the ear length of 10 cm, which runs through the side of the neck. After dissection of soft tissue the surgeon separates the artery. In carrying out these actions need to be careful. Nerves are shifted to the side, front veins are tied off.
- Heparin and compression of blood vessels.
- Dissection of the vascular wall. It allows you to get inside the artery. To ensure the cerebral circulation is established shunt, which stops blood flow in the operated part of the artery.
- Elimination of atherosclerotic deposits. Begin detachment of plaque in the carotid artery division. Plaque peeled off all over the vessel until a clear lumen.
- Rinsing the vessel. For this purpose, the artery is administered saline. Rinsing helps eliminate fat inclusions that can cause embolism. To restore the integrity of the vessel using autograft or artificial tissue.
- Removing the shunt, inspection of seams. After completing the operation alternately removed clips overlap the internal and external arteries. Soft tissue sutured, the wound drain.
eversion endarterectomy
This procedure is the removal of atherosclerotic contents of the vessel lumen. The intervention can be performed under local anesthesia with the introduction of hypnotics. Surgery to remove the plaque in the carotid artery includes the following steps:
- cut production. It starts behind the ear, runs through the mandible and ends in the sternum muscles. Thereafter, layers cut through the fatty tissue and muscle tissue.
- Separation of the internal carotid artery. Simultaneously occluded facial vein and nerve endings is withdrawn. Contact with the affected area should be minimal, otherwise you may provoke detachment and movement of an atherosclerotic plaque.
- Dissection of the artery. At this stage establishes a flexible shunt, provides blood flow to the brain vessels.
- Elimination of plaque. Separation begins at the site of arterial branching.
- Removing the shunt layer-stapling operation wound.
arterial stenting
The operation does not imply the implementation of a long incision. It is replaced with a puncture which is performed under general anesthesia. Through a puncture in the vessel cavity administered balloon that expands occluded vessel. Thereafter introducing a stent provides the required width of the lumen. Throughout the length of the artery set filters that prevent plaque detached into the systemic circulation.
arterial prosthesis
The method used for extensive atherosclerotic lesions and strong vascular tortuosity. During surgery, the affected portion of the artery is removed, then the remaining portions joined by a special device, which is a flexible synthetic tube. The size of the prosthesis is chosen before the start of surgery. After the operation is set drainage.
The postoperative period: complications and rehabilitation
The following complication may arise during the operation:
- ischemic injury of brain tissue (stroke occurs when a wrong conduct intervention);
- injury to the nerve endings;
- embolism;
- myocardial infarction;
- re-occurrence of atherosclerosis.
Maintaining the early postoperative period, it is carried out in a hospital environment. The first 24 hours of a patient spends in the intensive care unit. indicators of brain functioning here are tracked and the cardiovascular system, to provide emergency assistance in the development of complications. You can wake up the next day after the procedure. To normal life is gradually returning. During the year it is recommended to exclude any physical activity. In addition, required to comply with a special diet and taking all the medications prescribed by your doctor.
