What is Carotid Endarterectomy?
Carotid endarterectomy is a surgical procedure performed to treat carotid artery disease.
Carotid artery disease occurs due to the deposition of plaque (fatty substances) inside the walls of your carotid (neck) arteries. These arteries supply oxygen-rich blood from the heart to your brain. Due to plaque accumulation, the arteries become narrowed or may even become completely blocked. This reduces blood flow to your brain and creates oxygen-deficiency, increasing your risk of having a stroke.
Carotid endarterectomy restores proper blood flow to the brain. The surgery involves making a surgical cut in the neck area where the carotid arteries are located and removing fatty deposits that are narrowing the arteries and blocking the blood flow to the brain. The procedure reduces your risk of developing transient ischemic attacks (TIA) or stroke.
Indications for Carotid Endarterectomy
Your surgeon may recommend a carotid endarterectomy if you have:
- A severe blockage of a carotid artery of about 80 percent or more
- A moderate blockage of a carotid artery of about 50 to 79 percent and experiencing symptoms of mini-stroke, stroke, or TIAs
- Already had a TIA or stroke
Preparation for Carotid Endarterectomy
Pre-procedure preparation for carotid endarterectomy will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week before and two weeks after surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Continue taking your blood pressure medication on the day of surgery
- You may be asked to stop certain blood thinners prior to surgery including coumadin, Eliquis, Xarelto, Aspirin, Plavix.
- Most patients will stay in the hospital for 1 to 2 days after surgery.
- You may experience difficulty swallowing and a sore throat after surgery.
- You may experience numbness directly overlying the incision area.
- You may experience a headache for several days after surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Carotid Endarterectomy
A carotid endarterectomy procedure usually takes about 1 to 2 hours and is performed under general or local anesthetics based on your condition and your surgeon’s preference.
- You will be placed on the operating table on your back with your head turned away from the side to be operated on.
- Your surgeon makes an incision along the front side of your neck to reach the blocked or narrowed carotid artery.
- Next, your surgeon makes an incision in the narrowed section of the artery and removes the plaque or fatty substance that is blocking the normal blood flow.
- After removing the plaque, your surgeon makes the artery as clean and smooth as possible. Usually, a small patch made of a natural graft or a woven patch is stitched to the artery to prevent further narrowing.
- After confirming restoration of normal blood flow to the brain, your surgeon closes the incisions on the artery and the neck with layered sutures, and an adhesive bandage is applied.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after carotid endarterectomy will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- Most patients may need to stay in the hospital for 2 to 3 days before discharge to home.
- You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Application of cold and heat therapy on the operated area is also recommended to reduce inflammation and pain.
- Antibiotics are prescribed as needed to address the risk of surgery-related infection.
- Instructions on surgical site care and bathing will be provided.
- To prevent any chances of new plaque deposits, your doctor will recommend healthy lifestyle changes, such as:
- Eating an iron-rich and high-fiber diet that is low in fats, salt, and cholesterol
- Refraining from smoking as it increases the risk of chest infection, poor healing, and blood clots
- Regular exercises and walking with ample rest for gradual return to normal activity
- Maintaining a healthy body weight
- Refrain from lifting anything heavy for about 3 weeks post surgery.
- You will be able to resume your normal activities in 2 to 3 weeks but may have certain activity restrictions.
- Most patients will probably be able to return to work within 3 to 4 weeks.
- Complete recovery and return to work vary from patient to patient as it is related to a patient’s overall health status and the type of work one does.
- Refrain from driving until you are fully fit and receive your doctor’s consent. Most patients will be able to drive after 2 to 3 weeks of surgery
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Carotid endarterectomy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Blood loss
- Blood clots or deep vein thrombosis
- Anesthetic/allergic reactions
- Neurovascular injury
- Persistent pain in the operated area
- Heart attack