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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:
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:
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.
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.