Carotid Surgery in Hyderabad — Endarterectomy & Stenting

The carotid arteries run along either side of the neck and are the main channels supplying blood to the brain. When plaque narrows one of these arteries, fragments can break off and travel upward, lodging in a smaller brain vessel and cutting off its blood supply — this is the mechanism behind the majority of carotid-related strokes, distinct from the more familiar picture of a clot forming inside the heart.

A tight carotid narrowing, particularly one that has already caused a transient ischemic attack (a 'mini-stroke' with symptoms lasting minutes to hours) or a mild stroke, carries a significantly elevated risk of a larger, disabling stroke within the following weeks if left untreated. This narrow window is why carotid surgery, once indicated, is usually recommended promptly rather than being deferred.

Equally important, a proportion of significant carotid blockages produce no warning symptoms at all and are picked up incidentally during a routine check-up or a scan done for another reason — these 'asymptomatic' blockages still carry meaningful stroke risk and are evaluated just as carefully.

Carotid endarterectomy (CEA) is performed through a small incision along the natural skin crease of the neck, under general or regional anaesthesia depending on the patient's fitness and preference. The surgeon carefully exposes the carotid artery, temporarily clamps it, and opens it directly at the site of the blockage.

The diseased inner lining of the artery, along with the plaque causing the narrowing, is meticulously peeled away and removed, leaving a smooth, healthy channel behind. The artery is then closed, often reinforced with a patch to widen the repair and reduce the chance of future narrowing. Throughout the brief clamping period, cerebral blood flow is continuously monitored, and a temporary internal shunt can be used if needed to maintain blood supply to the brain.

The entire operation typically takes 90 to 120 minutes, and most patients are observed closely overnight in a monitored setting before being shifted to a regular room the next day.

For most patients with significant carotid disease, open surgery (CEA) remains the gold-standard treatment, carrying a slightly lower combined risk of stroke and death compared with stenting in large published trials, particularly in patients over 70. However, carotid artery stenting — a minimally invasive technique placing a stent through a groin or wrist puncture — is an excellent alternative for specific situations.

Stenting is often preferred in patients who have had prior neck surgery or radiation therapy, those with a carotid blockage positioned very high near the base of the skull that is difficult to reach surgically, or patients whose heart or lung condition makes general anaesthesia riskier. Dr. Sharma reviews each patient's anatomy, age, cardiac fitness and overall risk profile before recommending the approach most likely to give the safest, most durable outcome — rather than defaulting to one technique for everyone.

Recovery after carotid endarterectomy is generally swift — most patients are up and walking within hours of surgery, eating a normal diet by the next meal, and discharged within two to three days once the neck wound and neurological status are confirmed stable. Mild neck stiffness, soreness at the incision and slight hoarseness of voice can occur temporarily and typically resolve within a few weeks.

Beyond the operation itself, long-term stroke prevention depends heavily on continued medical management: antiplatelet therapy, a statin, and rigorous control of blood pressure, diabetes and cholesterol. Smoking cessation is particularly critical, as continued smoking significantly raises the risk of new plaque forming in the opposite, untreated carotid artery. Periodic duplex ultrasound follow-up monitors both the operated and the non-operated side for the years following surgery.