Friedrichshafen Clinic offers surgical treatment of carotid artery.
Thrombotic Endarterectomy is reconstructive surgery technique that is used to remove atherosclerotic plaque and restore vascular patency. During the operation, the inner wall is removed from the carotid atherosclerotic plaques.
The indications for surgery are diseases of the carotid arteries, which are accompanied by a significant narrowing of its lumen, especially in patients who have had transient ischemic attacks.
Treatment of carotid artery is performed under local or general anesthesia. General anesthesia is mostly used, as the surgery under local anesthesia is accompanied by unpleasant sensations that frighten the patient.
The cut of anterior surface of the neck is carried to gain access to the vessel. The carotid artery is separated and clamped to stop the blood flow. The blood supply of the brain is carried out through the opposite carotid artery after the ligation. As an alternative, during the operation you can impose a few grafts above and below the place where blood flow stops, to supply the brain with blood. Intraoperative monitoring using Doppler sonography is used to determine the state of blood flow in the vessels of the head and neck, which reduces the risk of postoperative cerebrovascular accident.
After carotid isolating, incision is carried over the spot of location of the plaque followed by scraping the wall. The wound on the neck is sutured, aseptic bandage is applied and the patient is transferred to the ward for observation. After surgery, the patient is kept under observation for 2-3 days. During this period, medical personnel not only monitor the state of post-surgical wound, but also control the patient's brain function to determine the status of cerebral blood flow.
Carotid artery surgery lasts 2 hours, the sutures are removed within a week, and the rehabilitation period takes 2-3 weeks.
Eversion thrombotic endarterectomy is an improved version of the above treatment method. This kind of surgery is used for treatment of carotid arteries with a small atherosclerotic plaque.
Access to the carotid artery is performed in the same manner as in the classical thrombotic endarterectomy, but the course of the operation has changed. After stopping the blood flow to the affected area of the vessel, the internal carotid artery is cut off from the bifurcation site. Plaque is separated from the wall and removed by eversion of the vessel up (the procedure is similar to removing a stocking from the foot), and then cut off. After removal of the pathological formation the normal structure of the carotid artery is restored, the vessel is sewn with sealed seam and, then, operation is finished.
Minimally invasive extension of constrictions by a balloon catheter is a variant of endovascular angioplasty.
The operation on the carotid arteries is performed under local anesthesia. The balloon catheter is introduced through the femoral artery into the iliac artery and thence reaches the carotid artery through the aorta. The operation is performed under the control of X-ray. After the introduction of the catheter in place of the pathological constriction, the doctor inflates the balloon with air, thereby recovering the normal patency of the carotid artery.
During a few days after surgery, the patient has been being under the supervision of medical staff. The total period of rehabilitation is 2-3 weeks.
The best effect of the procedure is obtained when the balloon dilatation of the carotid arteries following stent.
Balloon dilatation with the implantation of a stent is endovascular surgery for the treatment of the carotid artery constriction and restoration of the normal cerebral blood flow.
The advantages of balloon dilatation against thrombotic endarterectomy:
Cutting the femoral artery; arterial wall dissection; and attaching a port to prevent leakage of blood during surgery.
Introduction of a diagnostic catheter; contrasting and selection of a stent according to lesion characteristics.
Setting a filter trapping thrombus in the carotid artery.
Brining the balloon catheter with a stent in undisclosed condition to the point of constriction of the carotid artery. Stents are divided into self-opening and opening by inflating the balloon. The stent is individually selected by a doctor.
Checking the correct position of the stent and performing its final installation. This is the most crucial stage of the operation. If any unsatisfactory results, they are normally caused by mistakes in the final positioning of the stent. However, for the experienced doctor it is not a problem.
The balloon catheter is deflated and removed from the carotid artery together with the filter trapping thrombus.
The surgery time is about 45 to 90 minutes.
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