Carotid Endarterectomy

What is a carotid endarterectomy?

A carotid endarterectomy is a procedure in which a surgeon treats a blockage in a carotid artery.

You have two carotid arteries, one on each side of the neck. These blood vessels bring blood to the brain and eyes.

A blockage is usually a combination of cholesterol and calcium, called plaque, which has built up in your artery. The buildup of plaque can partially or fully block the flow of blood. When the carotid artery is narrowed or blocked, blood flow to your brain may be decreased. When the blood flow to your brain is decreased, you may become dizzy or faint, experience problems with eyesight in one eye, or have numbness or weakness in one side of the body.

When is it used?

A carotid endarterectomy is usually done when the carotid artery is more than 70% blocked. If the artery is not treated, you are at risk of having a major stroke.

When the blockage is less than 70%, some alternatives to this procedure include:

• taking aspirin or other medicines that thin your blood
• choosing not to have treatment, recognizing the risks of your condition.

You should ask your healthcare provider about these choices.

How do I prepare for a carotid endarterectomy?

Your healthcare provider will give you detailed instructions. They may include a suggestion to eat a light meal the night before the procedure and to not eat or drink anything after midnight before the procedure. If you regularly take any important medicines, your provider may ask you to take them on the day of surgery with a sip of water.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your body will heal much better if you do not smoke after the surgery.

If you take aspirin, warfarin (Coumadin), or vitamin E, ask your provider if you need to stop taking this medicine before your surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This may help to avoid extra bleeding during surgery.

What happens during the procedure?

You will be given a general anesthetic or a regional anesthetic called a neck nerve block. A general anesthetic will relax your muscles, put you in a deep sleep, and prevent you from feeling pain during the operation. With the neck block, you will be awake but will feel no pain.

The surgeon makes a cut (incision) in your neck and exposes the artery. A cut is made in the artery and the blockage is removed. The surgeon then repairs the artery and closes the incision in your neck with stitches.

What happens after the procedure?

At first you will stay in an intensive care unit or special-care postoperation unit. When your condition is stable, you will be taken to a regular room. You may stay in the hospital 1 to 2 days, depending on your condition. You may need medicine that makes the blood less likely to clot after the surgery. In a few weeks you may be able to return to a normal lifestyle.

Because you had plaque in your artery, you should eat less fat and try to exercise more after you have recovered from the procedure. Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You may no longer have problems with your sight or feel a weakness or numbness in your arms or legs. In addition, you may avoid having a major stroke.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• Because there is a blockage in the carotid artery, you may also have the same type of condition in your heart or other blood vessels. This increases the risk of a heart attack during the operation.
• It is possible for nerves in the neck to be injured, causing weakness of your voice box, speech function, or tongue muscles.
• You may have temporary changes in your blood pressure after the procedure.
• There is a possibility of a stroke during the operation or during the recovery period.

When should I call my healthcare provider?

Call your healthcare provider immediately if:

• You have trouble speaking or moving any part of your body.
• You lose your memory or have vision problems.
• You feel weak.
• You have difficulty breathing.
• You develop a fever.

Call your healthcare provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.