Συγκατάθεση για ενδαρτηρεκτομή καρωτίδας
The intended benefits: to reduce your risk of a future stroke by removing material narrowing the artery and widening the artery with a patch for long-term benefit.
Alternative treatments: drug treatment has already begun and will help but there is no evidence that these drugs will protect you as much as the surgery.
Angioplasty/stenting: is a relatively new treatment for carotid artery narrowing and is under trial. Results so far have not shown it to be better than surgery. Although some surgical complications are avoided, others occur, we don’t yet know long any benefit will last, and there is a higher risk of stroke than with surgery in most trials so far.
Serious or frequently occurring risks: there is a small risk of stroke during your operation and recovery (1-4%) this is kept low by careful monitoring and by giving you special drugs, including Clopidogrel and Heparin, plus controlling your blood pressure. There is a risk of injury to several nerves which lie close to the artery in your neck. Though we are careful to avoid these, injury can result in a numb or clumsy tongue, a drooping corner of your mouth, difficulty in swallowing or a hoarse voice which is the commonest problem. These effects are commonly on1ly temporary but in 2-3 % are permanent. Surgery always causes bruising and soreness and in most patients there will be numbness around the scar on your neck, often the ear too. Blood sometimes collects under the wound, this is called a haematoma, and on occasion this may need to be removed to make you more comfortable or active bleeding may need to further minor surgery to stop it. Whilst all fresh wounds are red and sore at first, occasionally this may worsen rather than improve and can indicate a wound infection requiring prompt review by a doctor and antibiotics. Infection of the patch used to widen your artery can occur rarely (<1%) and has risks of bleeding and stroke, this may need further surgery to remove the patch if it does not settle with antibiotics.
A rare problem is a severe headache with uncontrolled blood pressure which can lead to swelling of the brain, fits and haemorrhage if untreated, we call this Cerebral Hyperperfusion Syndrome and ask you to return to the hospital if you suffer a bad headache within a week or so of going home.
All major operations carry general risks, including heart problems. Many requiring this surgery already have a background of heart disease. The risk of heart attacks is around 1-2% and is kept low by our careful monitoring and control of blood pressure and your drugs.
Modern general anaesthetics are generally very safe and you will have the opportunity to discuss this in detail with your Anaesthetist or you may choose a local anaesthetic. For general anaesthetics, commoner side effects(1 in 10-100) include: nausea or vomiting, sore throat, dizziness, blurred vision, headache, itching, bruising and soreness, pain during drug injection, confusion or memory loss, aches, pains and backache. Uncommon problems (1 in 1000) include: chest infection, bladder problems, muscle pains, slow breathing, damage to teeth, lips or tongue or worsening of an existing medical condition. Rare complications (1 in 10,000-100,000) include damage to the eyes, serious allergy to drugs, awareness during surgery, nerve damage and equipment failure. Overall, death or major complications each occur in around only 1 or 2% of patients.
Any extra procedures which may become necessary during the operation:
- Blood transfusion is very rarely needed unless you are already anaemic but transfusions can result in severe allergic reactions or infections despite careful screening.
- Photographs and images are not a usual part of this operation but if we want them for teaching or research purposes, we would always ask you special permission.
Other procedures except for those listed above, are not required during this operation unless planned in advance.