Carotid Endarterectomy

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Things you need to know

What is Carotid Endarterectomy ?

Why do you need Carotid Endarterectomy ?

Carotid endarterectomy is indicated for:

Carotid artery stenosis:
- Significant narrowing (>70% stenosis with symptoms or 50–69% with high-risk features).
- Symptoms: TIA (mini-stroke, e.g., temporary vision loss, weakness), minor stroke, or amaurosis fugax (transient vision loss).
- Prevalence in India: 3–5% of adults over 60 years have significant stenosis; higher in diabetics, smokers, and those with hypertension.
Other indications:
- Asymptomatic stenosis (>70% with high-risk plaque features, e.g., ulcerated plaque on ultrasound).
- Failed medical therapy (e.g., antiplatelets like aspirin, statins not reducing stroke risk).
Associated treatments:
- Pre-op: Antiplatelets (aspirin, clopidogrel), statins to stabilize plaque.
- Post-op: Lifelong aspirin, blood pressure control, and smoking cessation.
Timing:
- Performed in adults (average age 60–80 years); urgent within 2 weeks of symptomatic event (TIA/stroke) for maximum benefit; elective for asymptomatic cases.

The procedure aims to reduce stroke risk by restoring normal blood flow to the brain, with a high success rate for stroke prevention in appropriately selected patients.

Why Do Carotid Endarterectomy Costs Vary in Philippines?

Carotid Endarterectomy Procedure

Before Surgery Evaluation:
- Assessment:
  - Imaging: Carotid ultrasound (first-line; measures stenosis), CT/MR angiography (confirms severity, plaque characteristics).
  - Blood tests: Blood sugar (diabetes control), cholesterol, clotting profile.
  - Brain imaging: CT/MRI if prior stroke/TIA to assess brain damage.
  - Cardiac evaluation: ECG, stress test (30% of patients have coexisting coronary artery disease, as in your angioplasty query).
- Preparation: Optimize blood pressure, stop smoking, fasting 6–8 hours.
- Consent: Risks, including stroke, are explained.
Surgical Technique:
- Carotid Endarterectomy:
  - Performed under general or local anesthesia with sedation, lasting 1–2 hours.
  - Process:
    - Incision: 5–10 cm along the neck, near the carotid artery (usually on the side of stenosis; 80% left-sided).
    - Carotid artery exposed; clamps placed above and below plaque (common, internal, external carotid).
    - Artery opened (arteriotomy); plaque removed using a dissector; artery cleaned of debris.
    - Shunt (optional, 20–30% of cases): Temporary tube to maintain brain blood flow during clamping (used if poor collateral flow).
    - Closure: Artery closed with a patch (e.g., Dacron or vein, reduces re-stenosis risk) or primary sutures; clamps removed.
    - Skin closure: Sutures (absorbable for skin); small drain (if needed, removed in 1–2 days).
- Intraoperative Tools:
  - Doppler ultrasound: Confirms flow post-repair.
  - EEG monitoring: Detects brain ischemia during clamping (if general anesthesia).
  - Heparin: Prevents clotting during surgery.
After Surgery:
- Hospital stay: 2–4 days.
- Care: Monitor neck for hematoma, neurological status for stroke signs; early ambulation to prevent clots.
- Pain management: Mild to moderate pain for 1–3 days (incision site); managed with painkillers (e.g., paracetamol).
- Instructions: Avoid neck strain for 2–4 weeks; continue antiplatelets, statins; monitor blood pressure.

Recovery After Carotid Endarterectomy

Hospital Stay: 2–4 days.
Post-Surgery Care:
- Pain: Mild to moderate pain for 1–3 days (neck incision); resolves in 1–2 weeks.
- Activity: Avoid strenuous activity for 2–4 weeks; light activities in 2–3 days; no neck twisting.
- Incision: Neck scar (5–10 cm) fades in 3–6 months; keep dry for 5–7 days.
- Symptoms: TIA/stroke risk reduced immediately; full benefit in 4–6 weeks.
- Medications: Lifelong aspirin (75–150 mg), statins; blood pressure control (<130/80 mmHg).
Follow-Up:
- Visits at 1 week (check incision), 1 month, and every 6–12 months (monitor carotid patency).
- Carotid ultrasound: At 1 month, then yearly; 90–95% patency at 5 years.

Most resume normal activities in 1–2 weeks; full recovery takes 4–6 weeks. Success rate: Reduces stroke risk by 50–70% in symptomatic patients (>70% stenosis); 5-year stroke-free rate 90–95% with proper management.

Risks and Complications

Surgical Risks:
- Stroke (1–3%): During or post-procedure; risk higher in symptomatic patients or if poor collateral flow.
- Bleeding (1–3%): Neck hematoma; may need evacuation (<1%).
- Infection (1–2%): At incision site; treated with antibiotics.
Post-Surgery:
- Cranial nerve injury (2–5%): Temporary hoarseness (vagus nerve) or tongue deviation (hypoglossal nerve); resolves in weeks.
- Restenosis (5–10% at 5 years): Re-narrowing; may need angioplasty (as in your prior query).
- Hyperperfusion syndrome (1–2%): High blood flow post-repair causes headache, seizures; managed with BP control.
- Heart attack (1–2%): Due to coexisting CAD; higher risk in elderly.
Long-Term:
- Progression of atherosclerosis (10–20%): In other arteries; managed with lifestyle changes, medications.
- Contralateral stroke (2–5%): If other carotid stenosed; may need staged CEA.

Report sudden weakness, vision loss, severe headache, or neck swelling promptly.

Frequently Asked Questions (FAQs)

What causes the need for carotid endarterectomy?

Carotid artery stenosis from atherosclerosis, increasing stroke risk, often with TIAs or minor strokes.

Can I avoid carotid endarterectomy?

Yes, if asymptomatic and low-risk: Medical therapy (aspirin, statins); CEA needed for symptomatic or high-risk stenosis (>70%).

Is carotid endarterectomy painful?

Mild to moderate pain for 1–3 days (neck incision); managed with medication; resolves in 1–2 weeks.

How soon can I resume normal activities?

Light activities: 2–3 days; full recovery: 4–6 weeks; avoid neck strain for 2–4 weeks.

Is carotid endarterectomy covered by insurance in India?

Often covered (medical necessity); confirm with your provider; Ayushman Bharat often subsidizes.

Signs of complications?

Sudden weakness, vision loss, severe headache, or neck swelling.

How effective is carotid endarterectomy at preventing stroke?

Reduces stroke risk by 50–70% in symptomatic patients; 90–95% stroke-free at 5 years with proper care.

Lifestyle changes post-surgery?

Quit smoking, control BP/cholesterol, take aspirin/statins, follow low-fat diet, and attend follow-ups.

Conclusion

Looking for Best Hospitals for Carotid Endarterectomy

Note: we are not promoting any hospitals

We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)

click on your city and schedule your surgery now done in good hands.

City	Minimum Price (₱)	Maximum Price (₱)
Angeles City	150,000	400,000
Antipolo	150,000	400,000
Bacolod	150,000	400,000
Bacoor	150,000	300,000
Baguio	150,000	400,000
Butuan	150,000	300,000
Cagayan de Oro	150,000	400,000
Caloocan	150,000	300,000
Cebu City	200,000	600,000
Dasmariñas	150,000	300,000
Davao City	200,000	600,000
General Santos	150,000	400,000
General Trias	150,000	300,000
Iligan	150,000	400,000
Iloilo City	150,000	400,000
Las Piñas	150,000	400,000
Makati	200,000	600,000
Malolos	150,000	300,000
Manila	200,000	600,000
Muntinlupa	150,000	400,000
Parañaque	150,000	400,000
Pasay	150,000	400,000
Pasig	200,000	600,000
Puerto Princesa	150,000	400,000
Quezon City	200,000	600,000
San Fernando	150,000	300,000
San Jose del Monte	150,000	300,000
Taguig	200,000	600,000
Valenzuela	150,000	300,000
Zamboanga City	150,000	400,000

Disclaimer

This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.