As you age, it is not uncommon for plaque (a gummy substance made of cholesterol, calcium, and fibrous tissue) to build up on the inside of artery walls. As more plaque accumulates, the arteries begin to narrow and stiffen causing atherosclerosis, or hardening of the arteries. When enough plaque builds up to interfere with blood flow in your carotid arteries, carotid endarterectomy may be necessary.
Carotid endarterectomy is often used to prevent stroke in patients with carotid artery disease. Patients with significant carotid artery plaque are at risk of developing clots on the arteries, which, along with plaque, may dislodge and travel to the brain. If a clot or plaque blocks a large artery and causes insufficient blood flow to the brain, an ischemic stroke can occur. Depending on how much of the brain is affected, permanent brain damage or even death may occur. If a clot or plaque blocks a tiny artery, a transient ischemic attack (TIA), or mini-stroke, may follow. A TIA may occur before a stroke, so doctors often see a TIA as a warning sign to begin treatment and, hopefully, reduce the risk of ischemic stroke.
To reduce your stroke risk, your doctor may perform a carotid endarterectomy, which is a common procedure performed by vascular surgeons. Many doctors choose carotid endarterectomy because it is a safe, long-lasting, and highly successful treatment option.
Preparing for Carotid EndarterectomyIf your doctor has recommended a carotid endarterectomy to treat your carotid artery disease, he or she may perform some tests prior to surgery to determine the extent of carotid blockage.
Most commonly, duplex ultrasound is used to assess the blood flow within the arteries. Duplex ultrasound is a painless procedure that uses high-frequency sound waves and a computer to create images of blood vessels. It can help your doctor determine the amount and location of plaque buildup in your carotid artery.
Other tests include:
The ProcedureCarotid endarterectomy may be performed under general or local anesthesia. Your surgeon may keep you awake during the procedure so that you are alert and able to communicate. An additional benefit of using local anesthesia is the ability to monitor your brain’s response to blood flow.
Once the anesthesia has taken effect, your surgeon will clean your neck to prepare to prevent infection. Then a small incision will be made in your neck at the site of the blocked carotid artery. Your carotid artery will then be clamped temporarily to restrict blood flow during the procedure. Your brain will still receive blood from the carotid artery on the opposite side of your neck. A more common alternative to clamping is inserting a shunt that creates a detour for blood to flow around the area that is being worked on.
Once blood flow has stopped in the area being repaired, your surgeon will make an incision into the carotid artery where the most plaque has built up. He or she will then extract the plaque deposits by removing the inner lining of the artery in that area. Sometimes a patch made of your own vein (typically taken from your leg) or of synthetic materials is used to widen the carotid artery. Once all plaque has been removed, and the patch is in place, your surgeon will stitch up your artery, remove the clamps or shunt, and ensure that all bleeding has stopped. Then your surgeon will stitch up your neck incision, and you will be transferred to a recovery room. Under normal circumstances, a carotid endarterectomy takes about two hours to perform with additional time needed for anesthesia and prep.
After the ProcedureOnce the carotid endarterectomy is complete, your hospital stay will typically last up to two days. You will receive fluids and nutrients intravenously, and your recovery will be monitored. Usually, serious pain with recovery is not an issue since the incision is so small.
When you leave the hospital, driving will be restricted, and physical exertion should be limited for several weeks.
If symptoms such as severe headaches, changes in brain function, or swelling in your neck occur, contact your doctor immediately.
Risks & ComplicationsCarotid endarterectomy is recommended for patients with moderate to severe narrowing of the carotid arteries—especially those who are experiencing TIAs. Patients who are otherwise in good health are ideal candidates for the procedure.
Patients with the following may have an increased risk of complications:
- Extensive stroke with no recovery
- Metastatic cancer with a short life expectancy (less than two years)
- High blood pressure
- Unstable angina (chest pains)
- Heart attack in the last six months
- Congestive heart failure
- Symptoms of progressive brain disorders, such as Alzheimer's disease
- Severe lung disease
- Plaque deposits that are not treatable with surgery
- Severe blockage in both branches of carotid artery
- Reoccurrence of blockage after previous carotid endarterectomy (restenosis)
Rarely, complications develop following a carotid endarterectomy. The risk of stroke is minimal, ranging between 1 and 3 percent. Restenosis, or the reoccurrence of a blockage, may also develop. The chance that restenosis will require a follow-up carotid endarterectomy is small, ranging from 2 to 3 percent. Smoking increases your risk of restenosis. A temporary injury to the nerves of the neck is uncommon but possible. If this complication occurs, you may experience hoarseness, trouble swallowing, and/or numbness in the face or tongue. This typically resolves itself within a month with no treatment.
It is important to note that your chance of having a stroke if your carotid blockage is left untreated far outweighs the risk of developing complications following a carotid endarterectomy.
Continuing Health after Carotid EndarterectomyEven though carotid endarterectomy is a long-term treatment for carotid artery disease, it does not stop new plaque from forming. Lifestyle changes and medications should be considered to reduce your risk of atherosclerosis.
- Quitting smoking
- Maintaining a healthy weight
- Eating a healthy diet low in saturated fat and calories
- Controlling cholesterol levels
- Exercising regularly
- Cholesterol-lowering medications and anti-platelet therapy