Definition

A surgical procedure to remove fatty deposits, also called atherosclerotic plaques, from the carotid artery. This artery travels through the neck and carries oxygen-rich blood to the brain.

	Carotid Artery
	© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

Carotid arteries located in the neck

Reasons for Procedure

This procedure helps to prevent stroke and transient ischemic attacks (TIAs) by restoring adequate blood flow to the brain. TIAs happen when the blood supply to the brain is temporarily blocked. People with TIAs have symptoms of a stroke, but unlike a completed stroke, these symptoms resolve within 24 hours. TIAs are considered a “warning sign” of an increased risk of stroke. People with severe blockages in their carotid arteries, especially those who have already had a stroke or a TIA, can benefit from carotid endarterectomy.

Risk Factors for Complications During the Procedure

• The degree of blockage in your carotid artery
• Diabetes
• The type of stroke symptoms you had
• Blockage of the carotid artery on the opposite side of your neck

What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Blood and urine samples
• Electrocardiogram (ECG, EKG) —a test that records the heart's activity by measuring electrical currents through the heart muscle
• Arteriogram—a type of x-ray in which a contrast material or dye is injected into the arteries to make them more visible
• Ultrasound —a test that uses sound waves to examine the carotid arteries
• Magnetic resonance angiography (MRA) scan —a test that uses magnetic waves, along with a paramagnetic contrast agent, to make pictures of arteries inside of the body

In the days leading up to your procedure:

• You will probably continue to take all major medications until the day of the surgery; check with your surgeon.
• The night before, eat a light meal and do not eat or drink anything after midnight.

During Procedure

Anesthesia

Anesthesia

General or local

Description of the Procedure

You lie flat, with a roll placed under your shoulder, and your head turned to the side. The surgeon makes an incision along the right or left side of the neck from just behind the ear to a point above the breastbone. The carotid artery is identified, clamps are temporarily placed above and below the plaque, and the artery is opened. In some cases, a shunt, which serves as a "bypass," is used to maintain blood flow.

The artery is cleaned of plaque. When all plaque has been removed, the artery is sewn back together and the clamps (and shunt, if used) are removed. The surgeon may need to remove a section of the carotid artery and sew in either an artificial graft or a segment of vein to replace it. The neck incision is closed with stitches.

After Procedure

The surgeon may do an arteriogram of the carotid artery to ensure that there are no complications, such as blood clots or narrowing. You may be given medication to help prevent blood clotting.

How Long Will It Take?

2-4 hours

Will It Hurt?

Occasionally, if local anesthesia is used and the area is not completely numbed, there may be some discomfort.

Possible Complications

• Heart attack
• Stroke
• High blood pressure (hypertension) or low blood pressure (hypotension)
• Blockage of carotid artery due to a blood clot (embolism)
• Possibility of nerve injury in the neck, resulting in weakness in the voice box or tongue muscles, which may affect speech
• Facial muscle paralysis (rare)
• Bleeding in the brain (rare)
• Earlobe numbness on the side where the carotid was repaired
• Infection
• Death

Average Hospital Stay

1-3 days

Postoperative Care

• Keep your neck straight, and keep the head of your bed elevated during recovery.
• Take medications as prescribed by your doctor. These may include anticoagulants to prevent blood clots, as well as prescription and nonprescription pain relievers.
• Resume your daily activities as soon as you are able.
• Do not drive for three weeks after surgery.
• Avoid vigorous exercise for six weeks after surgery.
• Make dietary changes to help prevent a recurrence of plaque build-up. These include eating a diet low in saturated fat and high in fruits, vegetables , grains , and fish. You may want to see a registered dietitian for help in making these dietary changes.

Outcome

The average recovery time is two weeks.

Successful completion of this procedure reduces the risk of stroke. In addition, any previous problems with vision loss, leg or arm weakness, or numbness should be improved or eliminated.

Call Your Doctor If Any of the Following Occurs

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
• Cough, shortness of breath, chest pain, or severe nausea or vomiting
• Memory loss or problems with vision
• Difficulty speaking or moving
• Weakness
• Arm pain
• Extreme sweatiness
• Dizziness

RESOURCES:

American Heart Association
http://www.americanheart.org

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org/

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/Page.asp?PageID=24

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

Questions and answers about carotid endarterectormy. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov . Accessed August 2003.

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