|Senator Edward M. Kennedy had been injured in a plane crash in 1964.|
Kennedy surgery routine, successful
Partially blocked artery cleaned out
Senator Edward M. Kennedy is "expected to make a full recovery" following surgery early yesterday to clean out a partially blocked neck artery that put him at risk of a stroke, according to his surgeon at Massachusetts General Hospital.
"The surgery was routine, uneventful, and successful," Dr. Richard Cambria, MGH's chief of vascular and endovascular surgery, said during a telephone news conference yesterday.
Kennedy, 75, is expected to be discharged over the weekend and return to work in about a week without any limitations. Doctors said they did not anticipate complications, but after discharge would recommend the senator take aspirin to prevent blood clots that might result from the operation, in addition to medicine he was already taking to control high blood pressure and cholesterol. There is a slight chance that the blockage could recur in the next few years.
Cambria said the one-hour operation was performed to prevent a stroke, which could have been triggered if the blockage in Kennedy's left carotid artery choked off blood flow and prevented oxygen from getting to the brain, or if a piece of the blockage broke off and lodged in the brain. Kennedy had no symptoms from the blockage, as is typical in many patients. In fact, he went sailing on Thursday before checking into MGH for the surgery that evening, according to his doctors.
The blockage was discovered Tuesday in a routine MRI conducted periodically to check on the senator's spine, which was injured in a 1964 plane crash.
Patients with blockages in one neck artery may have similar buildups of fat and cholesterol in other blood vessels as well, but Kennedy's doctors said there was no need for any treatment on his right carotid artery, and that he had passed a cardiac stress test prior to the surgery. Neither Cambria nor two other MGH doctors who treated Kennedy would discuss whether tests had turned up other evidence of blockages or problems.
"His overall health is excellent," said his personal physician, Dr. Laurence Ronan, adding that Kennedy would probably not have to change his lifestyle to prevent more health problems.
"His diet is very, very good," Ronan said, and the senator swims daily for exercise.
By yesterday afternoon, Kennedy was sitting up in bed, joking with staff about getting back to work, and visiting with his wife, Victoria Reggie Kennedy, and son, Representative Patrick Kennedy, Democrat of Rhode Island, according to Stephanie Cutter, a Kennedy spokeswoman. He had also heard from his two other children, Edward Jr. and Kara, who live outside the area, and received phone calls from Governor Deval Patrick, fellow Senator John Kerry of Massachusetts, Senator Chris Dodd of Connecticut, and Senate majority leader Harry Reid.
Cambria said the eldest Kennedy's mood was "extremely upbeat" and that he had snacked on ice cream and ginger ale. He planned to watch the televised game last night between the Red Sox and the Cleveland Indians.
Hundreds of thousands of patients nationwide have carotid arteries narrowed by fatty deposits, but many are treated with blood-thinning drugs or require no treatment. Surgery is recommended when the blockage becomes nearly complete, increasing the likelihood of stroke. About one-quarter of strokes are due to carotid artery disease, according to Dr. Louis M. Messina, chief of vascular surgery at UMass Memorial Medical Center in Worcester.
Carotid artery surgery is typically performed on patients who have had a stroke or transient neurological symptoms such as numbness or slurred speech, or patients with no symptoms but with an artery that is blocked by about 70 percent or more. Cambria said Kennedy's was "a very high-grade blockage."
The risk of stroke in patients like him who don't get the operation is about 12 percent, Messina said. After the operation, the stroke risk over the next five years is about 4 to 5 percent, he said.
About 115,000 patients nationwide had the surgery in 2005, the latest year for which national statistics are available. In the procedure, called carotid endarterectomy, doctors make a small cut in the neck to open the artery, and then scrape out the accumulated fat and cholesterol.
There is a small risk of complications, including stroke, heart attack, brain damage, blood clots, bleeding, and infections, which typically occur in the 24 hours after surgery. Mass. General doctors, who spoke to reporters at 3 p.m., said there had been no complications by that time.
An alternative surgery that is becoming more common for blocked neck arteries involves pressing the accumulated debris flat against the artery walls by inflating a balloon, and then inserting a metal stent to keep the blood vessel open. This procedure "appears to pose a higher risk of stroke or death" as a surgical complication than endarterectomy, according to Messina, but others say the procedure is less invasive and may allow faster recovery. Kennedy did not get a stent.
He first learned of the problem on Tuesday night after Mass. General doctors read the MRI results taken earlier in the day at Cape Cod Hospital and noticed the blockage. On Wednesday, Kennedy campaigned for Democrat Niki Tsongas in the Merrimack Valley, where she is running for the Fifth Congressional District seat. Then, he headed to Mass. General for more tests.
Cambria said doctors used a magnetic resonance angiogram to study his blood vessels and then an ultrasound to determine the extent of the blockage. Doctors told Kennedy that there was no emergency, but that he should have the operation soon, according to Cutter. He returned to the hospital on Thursday and was admitted.
Prior to the surgery, Kennedy's only serious hospitalization is believed to have been after the crash of a small private plane more than 40 years ago. Kennedy suffered several fractured back bones, broken ribs, and internal bleeding in the crash that killed two others.
Susan Milligan of the Globe staff contributed to this report. Dembner can be reached at firstname.lastname@example.org.