Carotid endarterectomy

The carotid arteries, on each side of the neck, carry blood to the brain. With age, smoking, high blood pressure or diabetes, an atheromatous plaque (a build-up of cholesterol and calcium) can form inside them and narrow the artery. Fragments of this plaque can break off and block a small artery in the brain: this is a stroke. Endarterectomy involves opening the artery through an incision along the neck, removing the plaque, then closing the artery, often with a small reinforcing patch to keep it wide. During the procedure the surgeon briefly stops the flow in the carotid; blood supply to the brain is monitored and, if needed, a temporary tube (shunt) keeps the brain supplied. This operation is offered when the narrowing is significant and has already caused warning signs (transient ischaemic attack, minor stroke, brief loss of vision in one eye), or for some very tight narrowings found without symptoms. The decision takes into account the duplex ultrasound, imaging, the neurologist's opinion and the patient's general health. In some cases, stenting by an endovascular route may be discussed. At Clinique Pasteur Tunis, carotid endarterectomy is performed in the operating theatre, with suitable anaesthesia and close monitoring during the first hours, in liaison with cardiologists and neurologists.