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Carotid Endarterectomy Surgery

What is carotid endarterectomy?

Carotid Endarterectomy

Carotid plaque being removed during surgery

Carotid endarterectomy is an operation during which we remove the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates plaque from your artery and can restore blood flow. Carotid endarterectomy is one of the most commonly performed vascular operations, and is a safe and long-lasting treatment.

Your carotid arteries are located on each side of your neck; these arteries supply blood to your brain. Carotid artery disease is a serious issue because clots can form on the plaque. Plaque or clots can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to your brain sufficiently, it can cause an ischemic stroke, which can cause permanent brain damage, or death, if a large enough area of the brain is affected. If a clot or plaque blocks only a tiny artery in the brain, it may cause a transient ischemic attack (TIA), also known as a mini-stroke. A TIA is often a warning sign that a stroke may occur in the near future, and it should be a signal to seek treatment soon, before a stroke occurs.

How do I prepare?

We will give you the instructions you need to follow before the surgery, such as fasting.

Before we perform a carotid endarterectomy, we may want to determine how much plaque has built up in your arteries. The most common test used for this purpose is duplex ultrasound. Duplex ultrasound uses painless sound waves to show your blood vessels and measure how fast your blood flows. It can also determine the location and degree of narrowing in your carotid artery. Other tests your vascular surgeon may use include:

  • Computed tomography (CT) scan
  • Computed tomographic angiogram (CTA)
  • Magnetic resonance angiography (MRA)
  • Angiography (or arteriography)

Am I eligible for carotid endarterectomy?

You are eligible for the procedure if you have severe narrowing of your carotid arteries, especially if you are experiencing TIAs and are in reasonably good health otherwise. You may be eligible, but at a relatively increased risk, if you have:

  • Had a large stroke without recovery
  • Widespread cancer with a life expectancy of less than two years
  • High blood pressure that has not been adequately controlled by lifestyle changes or medications
  • Unstable angina (chest pains)
  • Had a heart attack in the last six months
  • Congestive heart failure
  • Signs of progressive brain disorders, such as Alzheimer’s disease

Am I at risk for complications during a carotid endarterectomy?

Having had a stroke in the past increases your chances for complications to a varying degree depending upon its severity, how recently it occurred, and the degree of recovery. Other factors that may increase your chances for problems during a carotid endarterectomy, in addition to those conditions listed above, include:

  • The presence of a serious disease, such as severe heart or lung disease
  • Plaque your surgeon cannot reach through surgery
  • Severe blockage in other blood vessels that supply blood to your brain, such as the carotid artery on the other side
  • Having a new blockage in a previous carotid endarterectomy on the same side (recurrence)
  • Diabetes
  • Cigarette smoking

What happens during a carotid endarterectomy?

Carotid Endarterectomy Surgery

Carotid artery exposed during surgery

Carotid artery opened during surgery

Carotid artery “opened” during surgery

After your surgeon clamps your carotid artery, we make an incision directly into the blocked section. Next, we peel out the plaque deposit by removing the inner lining of the diseased section of your artery containing the plaque. After removing the plaque, we patch your artery, removes the clamps or the bypass, and stops any bleeding. We then closes your neck incision and the procedure is complete. The procedure takes about 2 hours to perform but may seem slightly longer depending upon the anesthetic and preparation time.

What can I expect after a carotid endarterectomy?

After surgery, you may stay in the hospital for 1 to 2 days. During this time, we will monitor your progress. Initially, during your recovery, you will receive fluid and nutrients through a small, thin tube called an intravenous (IV) catheter. Because the neck incision is so small, you may not feel significant pain.

After you go home, we may recommend that you avoid driving and limit physical activities for several weeks. You can usually begin normal activities again several weeks after the operation.

If you notice any change in brain function, severe headaches, or swelling in your neck, you should contact your physician immediately.

Are there any complications?

You may have complications following any surgical procedure. A stroke is one possible complication following a carotid endarterectomy. This risk is very low, ranging between 1 and 3 percent. Another unusual complication is the re-blockage of the carotid artery, called restenosis, which may occur later, especially if you continue to smoke cigarettes. The chance of developing a restenosis severe enough to require another carotid endarterectomy is usually about 2 to 3 percent. Temporary nerve injury, leading to hoarseness, difficulty with swallowing, or numbness in your face or tongue, is another uncommon, but possible, complication. This usually clears up in less than 1 month and usually doesn’t require any treatment. However, the chance of any of these unusual complications is much less than the risk of stroke if a significant carotid blockage is not adequately treated.

What can I do to stay healthy?

Although a carotid endarterectomy can reduce your risk of stroke by removing the offending plaque, and although the procedure is quite durable, it does not completely stop plaque from building up again in susceptible individuals. To minimize the chance of hardening of the arteries occurring again, you should consider the following changes:

  • Eat foods low in saturated fat, cholesterol, and calories
  • Exercise regularly, especially aerobic exercises such as walking
  • Maintain your ideal body weight
  • Avoid smoking
  • Discuss cholesterol-lowering medications and antiplatelet therapy with your physician