Carotid Endarterectomy (Surgery for Blocked Carotid Artery)

What is a carotid endarterectomy?

A carotid endarterectomy is surgery to remove a blockage in a carotid artery. The carotid arteries, one on each side of the neck, are blood vessels that bring blood to the brain and eyes.

A blockage is usually caused by a combination of cholesterol and calcium, called plaque, that has built up in your artery. The buildup of plaque can partially or fully block the flow of blood. A narrowing or blockage of a carotid artery can slow or stop blood flow to the head. It can cause temporary symptoms, such as dizziness, partial blindness, or numbness. It can also cause stroke or death.

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

When is it used?

This procedure is usually done when the carotid artery is more than 70% blocked.

Alternatives to this procedure may include:

• carotid angioplasty and stenting, which is a procedure that uses a balloon-tipped tube (catheter) to stretch the narrowed artery and a device called a stent to keep the blood vessel open
• aspirin or other medicines that thin your blood (if the blockage is less than 70%)

You may choose not to have treatment. Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Tell your healthcare provider about all medicines and supplements that you take.
• Your provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do.

What happens during the procedure?

The surgery is done at the hospital.

You will be given regional or general anesthesia to keep you from feeling pain. Regional anesthesia numbs part of your body while you stay awake. General anesthesia relaxes your muscles and you will be asleep.

Your healthcare provider will make a cut (incision) in your neck and then a cut in the artery. Your provider will remove the blockage. He or she will then repair the artery and close the cut in your neck with stitches.

The procedure should take 1 to 2 hours.

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 to help prevent blood clots after the surgery.

Ask your healthcare provider:

• how long it will take to recover
• what activities you should avoid
• how to take care of yourself at home and when you can return to your normal activities
• what kind of symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

Because you had plaque in your artery, you should eat less fat and try to exercise more after you have recovered from the procedure.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• Anesthesia has some risks. Discuss these risks with your healthcare provider.
• You may have infection or bleeding.
• 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 temporary changes in your blood pressure after the procedure.
• There is a possibility of a stroke during the operation or during the recovery period.

Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.