Book contents
- Frontmatter
- Contents
- Preface
- 1 The elective repair of an abdominal aortic aneurysm
- 2 Adrenalectomy
- 3 Amputation (below knee)
- 4 Anorectal abscesses, fistulae and pilonidal sinus
- 5 Appendicectomy
- 6 Principles of bowel anastomosis
- 7 Breast surgery
- 8 Carotid endarterectomy
- 9 Carpal tunnel decompression
- 10 Central venous cannulation
- 11 Cholecystectomy (laparoscopic)
- 12 Circumcision
- 13 Colles' fracture (closed reduction of)
- 14 Compound fractures
- 15 Dupuytren's contracture release
- 16 Dynamic hip screw
- 17 Fasciotomy for compartment syndrome
- 18 Femoral embolectomy
- 19 Femoral hernia repair
- 20 Haemorrhoidectomy
- 21 Hip surgery
- 22 Hydrocele repair
- 23 The open repair of an inguinal hernia
- 24 Laparotomy and abdominal incisions
- 25 Oesophago-gastroduodenoscopy
- 26 Orchidectomy
- 27 Parotidectomy
- 28 Perforated peptic ulcer
- 29 Pyloric stenosis and Ramstedt's pyloromyotomy
- 30 Right hemicolectomy
- 31 Skin cover (the reconstructive ladder)
- 32 Spinal procedures
- 33 Splenectomy
- 34 Stomas
- 35 Submandibular gland excision
- 36 Tendon repairs
- 37 Thoracostomy (insertion of a chest drain)
- 38 Thoracotomy
- 39 Thyroidectomy
- 40 Tracheostomy
- 41 Urinary retention and related surgical procedures
- 42 Varicose vein surgery
- 43 Vasectomy
- 44 Zadik's procedure
8 - Carotid endarterectomy
Published online by Cambridge University Press: 16 October 2009
- Frontmatter
- Contents
- Preface
- 1 The elective repair of an abdominal aortic aneurysm
- 2 Adrenalectomy
- 3 Amputation (below knee)
- 4 Anorectal abscesses, fistulae and pilonidal sinus
- 5 Appendicectomy
- 6 Principles of bowel anastomosis
- 7 Breast surgery
- 8 Carotid endarterectomy
- 9 Carpal tunnel decompression
- 10 Central venous cannulation
- 11 Cholecystectomy (laparoscopic)
- 12 Circumcision
- 13 Colles' fracture (closed reduction of)
- 14 Compound fractures
- 15 Dupuytren's contracture release
- 16 Dynamic hip screw
- 17 Fasciotomy for compartment syndrome
- 18 Femoral embolectomy
- 19 Femoral hernia repair
- 20 Haemorrhoidectomy
- 21 Hip surgery
- 22 Hydrocele repair
- 23 The open repair of an inguinal hernia
- 24 Laparotomy and abdominal incisions
- 25 Oesophago-gastroduodenoscopy
- 26 Orchidectomy
- 27 Parotidectomy
- 28 Perforated peptic ulcer
- 29 Pyloric stenosis and Ramstedt's pyloromyotomy
- 30 Right hemicolectomy
- 31 Skin cover (the reconstructive ladder)
- 32 Spinal procedures
- 33 Splenectomy
- 34 Stomas
- 35 Submandibular gland excision
- 36 Tendon repairs
- 37 Thoracostomy (insertion of a chest drain)
- 38 Thoracotomy
- 39 Thyroidectomy
- 40 Tracheostomy
- 41 Urinary retention and related surgical procedures
- 42 Varicose vein surgery
- 43 Vasectomy
- 44 Zadik's procedure
Summary
What are the indications for a carotid endarterectomy?
Carotid endarterectomy is indicated in symptomatic patients with symptoms suggestive of ischaemia in the carotid territory (TIA or Amaurosis Fugax) who have a major degree of carotid stenosis (between 70% and 99%). This is based on results from the European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Patients who have symptoms suggesting insufficiency of the vertebro-basilar circulation are not included.
There is currently a randomised clinical trial, which is looking at asymptomatic patients with carotid stenosis (the Asymptomatic Carotid Surgery Trial).
What are the clinical presentations of ischaemia of the carotid and the vertebro-basilar circulations?
Carotid: contralateral hemiparesis, hemianopia, hemisensory disturbances as well as dysphasia (dominant hemisphere) or visuospatial apraxias.
Vertebrobasilar: Vertigo, diplopia, dysphagia, dysphonia, nausea, vomiting or ataxia
What pre-operative measures should be taken?
To establish the diagnosis and grade the stenosis, duplex scanning is the investigation of choice in most centres. Patients were previously investigated using IADSA; but this itself carries a 12% risk of stroke. Some centres are now using magnetic resonance angiography (MRA) as an alternative. The patient will also require a CT scan of the brain to establish pre-operative infarcted areas.
Anaesthetic assessment and informed consent.
The patient should have an intravenous line and an arterial line in situ.
- Type
- Chapter
- Information
- Operative Surgery Vivas for the MRCS , pp. 27 - 30Publisher: Cambridge University PressPrint publication year: 2006