DRHOOK- Neck wear: Carotid artery plaque can be deadly

the handsome doctor John Hong

To stick out your neck for others is a noble thing to do– most of the time. It's good to stick out your neck for a friend in danger, like for Rihanna. It might not be a good idea to stick out your neck for a friend who is a thief and a liar, like OJ Simpson. It's a good thing to stick out your neck for something in which you believe, like how great Madonna still is.

It might not be a good idea to stick out your neck for something that is controversial, like how great Madonna still is.

What happens when sticking your neck out can be medically harmful?

Carotid Endarterectomy (CEA) is a surgical procedure to clean out the carotid artery in the neck. What's the carotid artery? You know how people check the pulse in the neck by the Adam's apple? That's the carotid artery. It's a fork in the road that goes into the brain (ICA: internal carotid artery) and up to the head (ECA: external carotid artery).

Arteries are much like pipes, and they can "corrode" and become clogged. But instead of potato skins, rust, and hair, the arteries become clogged with cholesterol in a situation called atherosclerosis. It decreases blood flow to the brain. 

The big problem with atherosclerosis in the carotid artery is if it throws things up into the brain to cause a stroke. Cholesterol plaque can dislodge and travel until it lodges in a small enough artery.

Also, ruptured plaque can form a clot from platelets (like a scab inside the artery),at can dam up the artery in the brain as well. (Low-dose aspirin is used to prevent this from happening!) The brain cells downstream from the clog die without blood flow in an event called an embolic stroke.

In a CEA, an incision is made in the neck to reveal the diseased carotid artery, and it is opened up and cleaned out. Some surgeons will patch it up with a synthetic patch like Dacron, which appears to prevent the artery from clogging up again as well as to reduce the likelihood of a stroke from that artery.

It is serious surgery, no doubt. No one wants a knife put to his/her throat. (It is so Godfather.) During or after the surgery, there is a risk of death up to 3 percent, depending on the skill of the surgeon and the patient's risk factors. Smokers have a higher risk of stroke and heart attack because nicotine creates havoc in arteries. 

Also folks with carotid atherosclerosis often have heart disease, too: smoking just isn't a good thing! Some people will have heart surgery or their coronary arteries opened up with stents prior or even during CEA, but studies have not shown that it lowers the risk of death. 

Many octogenarians undergo CEAs, and they are more at risk for heart attacks, strokes, and death within 30 days of surgery. Also folks with atherosclerosis in the other carotid artery are more at risk. Diabetics, who are at big risk for atherosclerosis and heart disease, are included in this high-risk group, as are those with kidney disease, recent stroke, and Chronic Obstructive Pulmonary Disease.

Restenosis (meaning clogging up the artery again) occurs in up to 10 percent of folks within five years. Unfortunately, doing a second CEA is more dangerous. So it's vital to control blood pressure, keep cholesterol down, not smoke, control diabetes, and take blood thinners after CEA.

It's nice to win, to be in the lead. Most people don't like to be neck-and-neck when it comes to the fight against strokes.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.