Carotid Endarterectomy

Carotid endarterectomy is a treatment in which our doctors remove harmful atherosclerotic plaque from your carotid arteries, reducing your risk of stroke. This procedure is only performed when the amount of blockage is severe enough to threaten a stroke. Endarterectomy is the most commonly performed vascular surgery procedure.

Your eligibility for an carotid endarterectomy is based upon the following criteria:

You have experienced a TIA or mild to moderate stroke caused by carotid stenosis;
You have a significant carotid blockage greater than 60 percent with symptoms;
You have a severe blockage even without any warning symptoms; or
You have no significant health issues which would make surgery difficult (radiation and or previous radical surgery to the neck)

A carotid endarterectomy is often preformed before heart surgery if there is severe blockage, to help prevent stroke during coronary artery bypass graft surgery.

You may not be a reasonable candidate for a carotid endarterectomy if you have any of the following risks:

You have a serious disease, such as uncontrolled cancer;
You had a large stroke without recovery;
You have high blood pressure that has not been controlled by lifestyle changes or medications;
The atherosclerotic plaque is surgically inaccessible; and
You have problems with other blood vessels in the head, such as cerebral aneurysm.

Carotid Endarterectomy Tests

Prior to the surgery, you may need to undergo one or more of the following tests:

Duplex Ultrasound Test

In an ultrasound test, the sonographer or doctor uses sound waves to make images of your carotid arteries. During the test, a special sensor is gently pressed to the side of your neck. An image of the artery and the blood flowing through it shows how severe the narrowing is.

CT Angiography

In CT angiography, a doctor uses a special contrast “dye” and x-ray images to make a map of your carotid artery. During this test, you lie in a scanner while a contrast dye is injected into a vein in your arm. The scanner then takes detailed pictures of the arteries.

Magnetic Resonance Arteriography

A magnetic resonance angiography (MRA) is an MRI that makes an image of your carotid artery without using x-rays.

Preparing for a Carotid Endartectomy

Your surgeon will give you instructions for preparing for a carotid endartectomy during your consultation.

The Carotid Endartectomy Procedure

During a carotid endartectomy, you will likely receive what is called a “cervical plexus block” with some sedation. You will be “awake” so that the doctor will be able to monitor your mental status, making the procedure much safer for you. This is not “general” anesthesia, so you are at lower risk for heart problems and stroke during the surgery.

Before surgery, your neck will be shaved and cleaned to reduce the chance of infection. You then are given a local anesthetic to numb the neck area. With a local anesthetic, you remain awake.

The doctor then makes an inicision on the side of your neck and opens the blocked carotid artery. The doctor clamps the blocked carotid artery to stop blood from flowing through it or inserts a temporary bypass (shunt) to detour blood around the artery and to the brain. If the artery is clamped, your brain receives blood from the carotid artery on the other side of your neck.

The surgeon then removes or peels out the plaque deposit by removing the inner lining of the diseased section of artery. Once the artery is free of plaque, the artery is stitched and the clamps are removed. The surgeon then closes the neck incision to complete the procedure.

A typical procedure takes about 1 to 1 ½ hours to perform.

Carotid Endartectomy After Surgery Care

Expect to stay in the hospital for one to two days after the procedure. During this period, you are checked for any sign of bleeding in the neck area, or changes in blood pressure. Pain should be minimal after the procedure.

Once at home, you may be told to avoid driving and limit physical activitiy for 1 to 2 weeks. Normal activities can be resumed after that time. Please remember that any change in mental status, severe headaches, or sudden severe swelling in your neck should be communicated to your surgeon immediately.

Possible Complications

Like all surgical procedures, there are risks associated with a carotid endartectomy. These include:

Stroke - Although unusual, in 1 to 3 percent of carotid endartectomies, a patient has experienced a stroke. Our surgical stroke rate is <1% .
Re-blockage of the carotid artery (restenosis) - This is more likely if you continue to smoke cigarettes, uncontrolled cholesterol problems and /or you are diabetic.
Temporary injury to the neck nerves - This may cause you to be hoarse, have the sensation of difficulty swallowing, or experience numbness in your face, neck or tongue. In most cases, this is temporary and clears up during your recovery period. Nerve injury resolution can occur up to 6 months after surgery.

Staying Healthy After a Carotid Endarterectomy

While it is true that a carotid endarterectomy reduces your risk of stroke, plaque can build up again in the carotid arteries. To prevent the buildup of life-threatening plaque, some lifestlye changes can help in the prevention:

Avoid foods that are high in saturated fat, cholesterol, and calories
Workout. Studies have proven that aerobic exercise, such as walking, reduces your risk of heart disease
Maintain your ideal body weight
If you smoke, quit. There are multiple medications and programs available to help with this.
Discuss cholesterol lowering medications and antiplatelet therapy with your physician.
Control your diabetes.

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