Samantha a 54-year-old working mum recently had a stroke. At 54 she’s 20 years younger than average female stroke patient. She’s at the Freeman Hospital to have surgery to unblock an artery in her neck.
“I took a funny turn, I’d fallen to my right-hand side, I had slurred speech, I couldn’t speak – I knew what I wanted to say but I couldn’t get the words out.
“I couldn’t feel my whole right arm, my right hand and I was blue lighted to the emergency hospital in Cramlington and that’s when they’d discovered I’d had a mini stroke it came as a shock – a bit of a wakeup call.” Explains Samantha.
Performing her surgery is endovascular surgeon Criag Nesbitt who explains “A stroke is where there has been an interruption of the blood supply to a part of the brain. That part of the brain can be starved of blood and oxygen and that part of the brain can die.
“What strikes me about Samantha’s case is that she is so young and has young kids and the consequences of her having a major stroke at that age would be devastating.”
Craig will be operating on Samantha’s carotid artery. Which is one of a pair of blood vessels located on either side of the neck that delivers blood and oxygen to the brain.
Her scans show the blood vessels on her right side look great – the left side is where the problems are visible.
The MRI shows the area where there is no blood flow in Samantha’s carotid artery – which is her stroke risk. Craig says: “Whatever it is in here that is narrowing that pipe – she’s a sitting duck really I’m afraid for another stroke.
“That might be a mild event, or it might be partially disabling, it could be fatal so the sooner in principle we can get that artery cleared out and remove that plaque from circulation the quicker we can reduce her risk of having a stroke.”
For Samantha this is potentially life-saving surgery.
It’s a risky surgery as Craig explains to Samantha: “There are risks – despite our best efforts unfortunately we do have some patients who will have a stroke during surgery.
“I want to tell you that won’t happen – I’m not allowed to tell you that won’t happen, but I want you to know that we have very low stoke rates in the Freeman and I think we can only take every precaution possible. To stop that from happening.”
In theatre 9 Craig is preparing to operate on Samantha – she’s nervous “I’m anxious about if anything goes wrong, will I come out the other side there are risks in the surgery.” She says.
Before he can remove the blockage Craig’s first challenge is to get to the artery itself.
Craig explains: “There’s a muscle that ruins in the neck and the carotid artery is behind that. The first part of the surgery is coming through an incision to move everything out the way so we can get to the artery.
“Then we’ll clean the artery out and then close everything back over again and wake her up and fingers crossed she’s behaved herself.
“There is no margin for error really. There are a few things that are going through your mind because in the neck there isn’t a lot of wiggle room in terms of the number of structures that are in there it’s all pretty congested.”
Craig cuts through the first layer of muscle to get down to the carotid sheet. He is now operating next to the nerve which controls Samantha’s tongue where one false move could have devastating consequences.
Craig continues “This is the structure we’re wrestling with at the moment – this is the hypoglossal nerve which is running right where we’re wanting to be. We’re just gently lifting it off her, but it is a little bit stuck down so we’re just taking our time and we’re trying to be vigilant – she would be quite significantly disabled if we damaged that.
“My sole purpose is to not even touch the nerve but in Samantha’s case we have to lift it off the artery.”
Any damage to the nerve risks permanently damaging Samantha’s ability to swallow or speak.
Craig is one hour into surgery; he needs to remove the blockage but there’s a risk of causing another stroke. He has navigated around the nerve controlling Samantha’s tongue his team now need to repair the diseased artery.
Craig can finally see the internal carotid as it goes up into the brain and it’s time to remove the plaque. Craig explains: “The plaque itself may not look terribly impressive but it can have such a devastating effect. If it lands in a blood vessel supplying a part of the brain that is crucial and it blocks that blood vessel and stops that part of the brain from working because it dies that’s your stroke.”
Craig carefully removes the build-up of plaque – removing the blockage from Samantha’s artery.
With Samantha under sedation craig won’t know how the operation has gone until she wakes up. Craig and the team finish and close.
Following surgery Craig checks in Samantha – she’s doing very well she’ll have a funny tongue for a little while because of the location of the nerve but everything went really well.
Back at home Samantha has recovered from her stroke surgery and is on a mission to lower her cholesterol.
