Carotid Artery Endarterectomy
Definition |
Body Parts Involved |
Reasons for Procedure |
Complications |
What to Expect |
Outcome |
Call Doctor If
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.
Parts of the Body Involved
Carotid arteries located in the neck
Reasons for Procedure
To help prevent stroke and transient ischemic attacks (TIAs) by restoring adequate blood flow to the brain. A TIA is a mini stroke caused by a temporary blockage in an artery.
Risk Factors for Complications during the Procedure
Presence of these health issues:
- Obesity
- Smoking
- Excess alcohol consumption
- Diabetes
Use of the following medications:
- Antihypertensives (high blood pressure medication)
- Insulin
- Muscle relaxants and sedatives
- Mood-altering drugs
Carotid endarterectomy is not recommended for people with these conditions:
- Recent heart attack
- Dementia
- Angina
- Advanced malignancy
- Less than 50% artery blockage
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
- MRI scan – a test that uses magnetic waves to make pictures of the 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 you 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, and heparin is given. This is a blood-thinning medication that helps prevent formation of blood clots. Clamps are placed above and below the plaque to control blood flow. 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 shunt (if used) is also 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 surgeon may also temporarily leave a small, flexible tube in the incision to drain accumulated fluids. The incision is closed with stitches.
After Procedure - The surgeon may do an arteriogram of the carotid artery to insure 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, and prescription and non-prescription pain relievers.
- Resume your daily activities as soon as you are able.
- Do not drive for 3 weeks after surgery.
- Avoid vigorous exercise for 6 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 2 weeks.
Successful completion of this procedure reduces the risk for stroke. In addition, any previous problems with vision loss, or 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
SOURCE:
American Heart Association
Last reviewed March 2001 by Medical Review Board
