Carotid Endarterectomy

What is a carotid endarterectomy?

A carotid endarterectomy is a procedure in which a surgeon removes a blockage in a carotid artery.

You have two carotid arteries, one on each side of the neck. These blood vessels bring blood to the brain and eyes.

A blockage is usually a combination of cholesterol and calcium, called plaque, which has built up in your artery. The buildup of plaque can partially or fully block the flow of blood. When the carotid artery is narrowed or blocked, blood flow to your brain may be decreased. When the blood flow to your brain is decreased, you may become dizzy or faint, experience problems with eyesight in one eye, or have numbness or weakness in one arm and leg.

When is it used?

A carotid endarterectomy is usually done when the carotid artery is more than 70% blocked and symptomatic. If the artery is not treated, you are at risk of having a major stroke, though with medicines, this can be delayed or avoided in consultation with the vascular medicine or surgery specialist, weighing the risk versus the benefits.

When the blockage is less than 70%, some alternatives to this procedure include:

taking aspirin or other medicines that thin your blood
choosing not to have treatment, recognizing the risks of your condition.

You should ask your health care provider about these choices.

How do I prepare for a carotid endarterectomy?

Your health care provider will give you detailed instructions. They may include a suggestion to eat a light meal the night before the procedure and to not eat or drink anything after midnight before the procedure. If you regularly take any important medicines, your provider may ask you to take them on the day of surgery with a sip of water. You probably need premedication with Bicitra and mucomyst (Can be obtained online in easier to take capsule form at avmazon.com. Otherwise, see about a prescription for this. Do not take the metformin (Glucophage) for 2 more days after.

What happens during the procedure?

You will be given a general anesthetic or a regional anesthetic called a neck nerve block. A general anesthetic will relax your muscles, put you in a deep sleep, and prevent you from feeling pain during the operation. With the neck block, you will be awake but will feel no pain.

The surgeon makes a cut (incision) in your neck and exposes the artery. A cut is made in the artery and the blockage is removed. The surgeon then repairs the artery and closes the incision in your neck with stitches.

What happens after the procedure?

At first you will stay in an intensive care unit or special-care postoperation unit. When your condition is stable, you will be taken to a regular room. You may stay in the hospital 1 to 2 days, depending on your condition. You may need medicine that makes the blood less likely to clot after the surgery. In a few weeks you may be able to return to a normal lifestyle.

Because you had plaque in your artery, you should eat less fat and try to exercise more after you have recovered from the procedure. Ask your health care provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You may no longer have problems with your sight or feel a weakness or numbness in your arms or legs. In addition, you may avoid having a major stroke.

What are the risks associated with this procedure?

There are some risks when you have general anesthesia. Discuss these risks with your health care provider.
The regional anesthetic (neck block) may not numb the area quite enough and you may feel some minor discomfort
Because there is a blockage in the carotid artery, you may also have the same type of condition in your heart or other blood vessels. This increases the risk of a heart attack during the operation.
It is possible for nerves in the neck to be injured, causing weakness of your voice box, speech function, or tongue muscles.
You may have changes in your blood pressure after the procedure. This is usually temporary.
There is a possibility of a stroke during the operation or during the recovery period.

You should ask your health care provider how these risks apply to you

When should I call my health care provider?

Call your health care provider immediately if:

You have trouble speaking or moving any part of your body.
You lose your memory or have vision problems.
You feel weak.
You have difficulty breathing.
You develop a fever.

Call your health care provider during office hours if:

You have questions about the procedure or its result.
You want to make another appointment.