65-year-old bus driver Ken is at the Freeman Hospital to have surgery after he had a stroke six weeks ago.
Ken says: “I felt a little bit dizzy, a little bit light headed and my wife noticed and she said there’s something wrong because you’re not talking properly.”
Ken was taken to A&E and referred to the stroke ward. “They checked me overnight and said I’d be ok to go home and about 4 or 5 days later it happened again.” Continues Ken.
Scans revealed that both main arteries taking blood to Ken’s brain are blocked – a condition that could kill him.
One is beyond repair however endovascular surgeon Craig Nesbitt will attempt to unblock the other one – to hopefully prevent Ken having another stroke.
Understandably Ken is nervous before surgery, but Craig explains the risks and why surgery is so important for Ken. “We can’t make the risk of you having a stroke on the table zero, but we can make it as close to zero as we can.” Says Craig.
Craig continues “He’s interesting because he’s worked all his life and you can teel this has really hit him for six. He’s a joker but I can tell that he’s terrified.”
As Ken gets ready to go to theatre, he shares what he’s looking forward to the most. “I’ve got butterflies because I know I’m going into this operating theatre and it’s your brain. I’m really looking forward to just getting back to normal life and I haven’t got to worry about what’s happening in the future.”
The operation involves effectively switching off Ken’s brain. Craig needs to cut off the blood supply to one half of Ken’s brain using clamps in order to access the damaged artery, but this carries with it serious risks.
Craig explains: “His risk of having a stroke once the clamps are on and the brain is switched off is high but that risk is significantly lower than the risk of having a stroke if we don’t do the surgery.”
Craig’s first challenge is finding the artery he explains: “There is very little margin for error in that part of the neck. There’s not a lot of space to move around and it’s all pretty congested. There are some big veins there are some incredibly important nerves.
“The first part of the surgery is just fining where you want to be – moving things that are in the way – out of the way.
“There is something called the hypoglossal nerve which is something you never want to see – it’s going to be in the way. That’s the nerve that controls the tongue and if that’s damaged the worst side of things is that your patient is not going to be able to eat, swallow, speak.”
He continues “It’s nerve wracking, if my sole purpose is to not even touch the nerve the thought of having to mobilise it and lift it up and peel it off the artery – it focusses the mind that’s for certain.”
With the major nerve successfully moved out of harm’s way, Craig now needs to insert a shunt to temporarily divert blood around the diseased section of Ken’s artery.
He can’t insert the shunt until he blocks off the blood supply to the artery directly above and below the diseased section using clamps. Once everything is in place it is time for the critical part of the surgery.
Craig is ready to apply the clamps but once he does the nerve supplying blood to the left side of ken’s brain will be cut off. “As soon as we put the clamps on – in my head – I’ve switched the brain off. I’ve got to think that side of the brain is starved of blood and oxygen. Any length of time with shunts on basically stopping blood to one part of your brain – even one second is too long.”
With the temporary shunt finally in place, blood flow is returned to Ken’s brain and Craig can now begin to remove the blockage from the diseased section of artery.
The artery is filled with plaque – a build-up of impurities that form into a mass. It gets deposited in the walls of the blood vessels and this is what can cause a stroke.
Once Craig has cleared the artery it is flushed through to make sure all of the plaque has gone, and blood flow can be reestablished.
Craig needs to remove the temporary bypass which means he once again has to stop the blood flow to Ken’s brain.
With the shut and clamps removed, and the blockage cleared blood is now flowing through the artery and into Ken’s brain. With a final blood flow check using a doppler now complete its time for Ken to go to recovery.
Ken is home and feeling a lot better – he’s back behind the wheel but is planning to retire.
