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"What is a carotid endarterectomy?"


What is a carotid endarterectomy? After my dad had a stroke very recently, his doctor said he was a good candidate for this procedure. I get that it's a way of cleaning his veins out, but I just don't understand how the process is supposed to work.


A carotid endarterectomy is a surgical procedure in which occluded carotid arteries (the arteries responsible for the vast majority of blood flow to the brain) are cut open and the atherosclerotic plaque that is occluding the artery is carefully dissected out by a surgeon. Normally this procedure is indicated when a patient has a stroke (like your father) or a transient ischemic event (TIA) in conjunction with evidence of blockage in one or both of the carotid arteries. In order to understand why carotid endarterectomy is effective, one must first understand the basic pathophysiology of an ischemic stroke.

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Essentially, an ischemic stroke is cause by brain tissue damage or death in the setting of decreased blood flow. As mentioned, the carotid arteries are the brain's main blood supply. If these arteries are blocked to a significant degree, the brain is at risk for being underperfused with any physiological stress that my lower the systemic blood pressure. think of two hoses pointing straight up with water flowing through them from a reservoir pump (ie your heart). if the hoses are kinked, the stream of water coming out of them will be diminished and if the reservoir becomes low on fluid or the pump is working poorly even less water is going to make it through the kinked hose and out. same thing with the carotid arteries, the more occluded they get, the more at risk the brain is for underperfusion and ischemic stroke. Carotid endarterectomy effectively 'unkinks' or, more appropriately, unclogs the carotids so that the flow of blood to the brain has less impedance and in doing so greatly reduces the risk of ischemic stroke.

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