Carotid Endarterectomy
Carotid Endarterectomy
by Monica Zangwill, MD, MPH
Anatomy and Physiology
 The carotid artery is the major blood vessel in the neck, which carries oxygen–rich blood from the heart to the brain. There are two carotid arteries, one on each side, which you can feel directly as the pulse in the side of your neck.
Reasons for Procedure
 Fatty deposits, called atherosclerotic plaques, can build up inside the carotid artery. These plaques can narrow the passageway of the artery and interfere with blood flow to the brain. This blockage or narrowing is called a stenosis.
If blood flow to the brain is blocked, a stroke can occur. This can happen when there is a complete blockage of the carotid artery. Most strokes, however, occur when pieces of the plaque or blood clots in the area, called emboli, break off and travel downstream with the blood, totally blocking smaller vessels in the brain.
If blood flow to the brain is blocked temporarily, a transient ischemic attack, also known as a TIA, may occur. People with TIAs have symptoms of a stroke, but unlike a stroke, their symptoms go away within 24 hours. Most people with a carotid artery narrowing, or stenosis, have no symptoms of stroke or TIA, making this problem even more dangerous.
Treatments
Your doctor will recommend treatment based on your symptoms, medical history, and the severity of your carotid artery narrowing. Doctors usually treat people who have carotid artery narrowing of less than 70\% with blood–thinning medicines.
 If you have a severe narrowing of the carotid artery or symptoms of a stroke or TIA, your doctor may recommend surgery to remove the plaque from your carotid artery. This type of surgery is called carotid endarterectomy. If your artery has become completely blocked, no medical or surgical treatment is available to unblock it.
A carotid angioplasty may be another option for some individuals at high risk for carotid endarterectomy surgery. In this procedure an expanding balloon is used to open the artery.
Procedure
In the days leading up to your procedure: arrange for a ride to and from the hospital and for help at home as you recover. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, herbs, or dietary supplements, your doctor may recommend temporarily discontinuing them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor
Before the procedure, an intravenous line will be started. A carotid darterectomy is usually done under general anesthesia, which will put you to sleep for the duration of the procedure. In this case, a breathing tube will be inserted through your mouth and into your windpipe to help you breathe during the operation.
Sometimes a carotid endarterectomy is done with local anesthesia. If local anesthesia is used, you will remain awake, but your neck will be numbed. You will probably also receive some sedation.
The surgeon will make an incision along your neck on the side of the blocked artery. The incision may run from just behind the ear to a point above the collarbone.
Your surgeon will find the carotid artery and temporarily clamp off blood flow through it. Your surgeon may place a shunt or temporary bypass to keep blood flowing to the brain.
Your surgeon will open up the artery and remove the plaque. After the blockage has been removed, he or she will sew the artery back together, usually placing a patch in the artery to widen it slightly. The patch may be made of part of one of your veins, or an artificial material, such as Dacron.
Finally, your surgeon will close the incision with sutures or staples and cover it with bandages. A temporary drain is frequently left in the wound.
Risks and Benefits
Possible complications of carotid endarterectomy include: heart attack, stroke, complete blockage of the carotid artery, high or low blood pressure, nerve injury in the neck resulting in weakness of the voice box, tongue, or facial muscles, which may affect speech, leakage of blood from the sewn artery, which can cause bleeding in the neck.
Additional complications include: skin numbness around the site of the incision, wound infection, adverse reactions to general anesthesia, lung problems, and/or death.
Benefits of a carotid endarterectomy include: reduced risk of future stroke, reduced risk of transient ischemic attacks, or TIAs.
After the Procedure
After the operation, you will be taken to a recovery area where the staff will monitor your vital signs and neurologic condition. During the hospitalization, you will be given pain medication as needed, and you will gradually progress from a liquid to a solid diet. Most patients go home 1–2 days after their surgery.
Once you are home: keep your neck straight and the head of your bed elevated during recovery. Take the medications prescribed by your doctor; these may include blood–thinning medicines and 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.
Be sure to call your doctor if any of the following occurs: signs of infection such as fever and chills, redness, swelling, increasing pain, excessive bleeding, or discharge at the site of your incision, cough, shortness of breath, or chest pain, severe nausea or vomiting, memory loss or problems with vision, difficulty speaking or moving, weakness, extreme sweatiness or dizziness.
Sources:
Carotid artery stenosis. American Heart Association. Available at: http://www.americanheart.org/
presenter.jhtml?identifier=4497 Accessed June 23, 2004.
Carotid endarterectomy. American Stroke Association. Available at: http://strokeassociation.org/
presenter.jhtml?identifier=4487 Accessed June 23, 2004.
Carotid endarterectomy. Queensland Government. Available at:
http://www.health.qld.gov.au/informedconsent/ConsentForms/vascular/carotid_endarterect.pdf
Accessed June 23, 2004.
Let,Aeos Talk About Carotid Endarterectomy American Stroke Association. Available at:
http://strokeassociation.org/downloadable/stroke/107523915161950–0059\%20ASA\%
20Endarterectomy.pdf Accessed June 23, 2004.
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