The artery in the neck supplying the brain – the carotid artery, can become narrowed with atherosclerosis. This atherosclerotic lesion can trigger a stroke by causing particulate matter (cholesterol and platelet emboli) to break off and block small downstream vessels in the brain, or the narrowing itself may become very severe to cause the vital blood flow to the brain to reduce or stop, in turn causing the brain to cease function and part of the affected brain to die. The clinical effect can be amplified by periods of low blood pressure (hypotension) or if other blood vessels to the brain (collateral supply) are already affected by narrowing.
Carotid endarterectomy involves surgical removal of the atherosclerotic lesion or “plaque” to prevent the risks of stroke. Stroke can be debilitating leaving permanent sensory, motor, speech and/memory problems, or if severe enough result in death. Benefits of treatment are greater if you are suffering warning signs or mini strokes – so called transient ischaemic attacks (TIA’s).
Dr Chu performs two different ways of removing the plaque. One way is to open the artery lengthwise, shell out the plaque and close the artery up with an artificial patch. The other way involves dividing the artery completely then peeling the wall of the artery back like skinning a sausage, shelling out the plaque, and rejoining the artery up. The surgery itself carries a very small risk of causing a stroke but the risk of this is much smaller than if no surgery was performed to remove the plaque. In Dr Chu’s hands, the risk of stroke from surgery is less than 1%.