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  • Carotid Artery Endarterectomy

    Definition

    The carotid artery carries blood through the neck to the brain. Blockage of this artery can lead to brain damage called a stroke.
    A carotid artery endarterectomy is a surgery to remove the deposits from this artery. Deposits in arteries result in plaque. This can slow and even stop blood from flowing through the artery.
    Carotid Artery
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    Reasons for Procedure

    This procedure helps to restore proper blood flow to the brain. This will help to prevent strokes and transient ischemic attacks (TIAs) . TIAs are considered a warning sign of a coming stroke.

    Possible Complications

    If you are planning to have an endarterectomy, your doctor will review a list of possible complications, which may include:
    Factors that may increase the risk of complications include:
    • Smoking
    • The degree of blockage in your carotid artery
    • Blockage of the carotid arteries on both sides of your neck
    • Diabetes

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Blood and urine tests
    • 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
    • Magnetic resonance angiography (MRA) scan —a test that uses magnetic waves, along with a contrast agent, to make pictures of arteries inside of the body
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    The night before, eat a light meal. Do not eat or drink anything after midnight.

    Anesthesia

    You and your doctor will discuss using either:

    Description of the Procedure

    You will lie flat on a table. A roll will be placed under your shoulder. Your head will be turned to the side. A cut in the skin will be made along the side of the neck. The cut will run from just behind the ear to a point above the breastbone. Clamps will be placed above and below the plaque on the carotid artery. In some cases, a temporary bypass tube will be used to maintain blood flow around the area that is being operated on.
    The artery will be opened and cleaned of plaque. The artery will then be sewn back together. The clamps (and bypass tube, if used) will then be removed. The doctor may need to remove a section of the carotid artery. In this case, an artificial graft or a segment of vein will be sewn in to replace it. The neck incision will be closed with stitches.

    Immediately After Procedure

    The doctor may do an arteriogram. This is to ensure that there are no complications, such as blood clots or narrowing. You may be given medicine to help prevent blood clotting.

    How Long Will It Take?

    2-4 hours

    How Much Will It Hurt?

    Anesthesia will prevent pain during the procedure. You will be given medicine to help manage any pain.

    Average Hospital Stay

    The usual length of stay is 1-3 days. Your doctor may choose to keep you longer if complications arise.

    Post-procedure Care

    At Home
    The average recovery time is two weeks. When you return home, do the following to help ensure a smooth recovery:
    • Keep your neck straight. Keep the head of your bed elevated during recovery.
    • Take medicines as prescribed by your doctor. Anticoagulants will help to prevent blood clots. Prescription and nonprescription pain relievers will help with any discomfort.
    • Resume your daily activities as soon as you are able.
    • Do not drive for three weeks after surgery or until your doctor says it okay.
    • Avoid vigorous exercise for six weeks after surgery.
    • Make dietary changes to help prevent a recurrence of plaque build-up. Eat a diet low in saturated fat. Make sure your diet is high in fruits, vegetables , grains , and fish. You may want to see a registered dietitian for help in making these changes.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Be sure to follow your doctor’s instructions .

    Call Your Doctor

    After you leave the hospital, contact 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
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Pain that you cannot control with the medicines you have been given
    • Severe headaches, swelling in your neck, or other new symptoms
    • Cough, shortness of breath, chest pain
    • Memory loss
    • Drooping facial muscles
    • Difficulty with speech, vision, or with moving
    • Weakness
    • Arm pain
    • Extreme sweatiness
    • Dizziness or fainting
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/

    Heart and Stroke Foundation of Canada http://www.heartandstroke.ca/

    References

    American Heart Association website. Available at: http://www.americanheart.org/ .

    Cleveland Clinic. Carotid Endarterectomy. Available at: http://my.clevelandclinic.org/services/endarterectomy/vs%5Fcarotid%5Fendarterectomy%5Foverview.aspx . Accessed on January 11, 2009.

    Ederle J, Brown MM. Managing carotid stenosis: carotid endarterectomy and stenting. Minerva Med. 2008 Oct;99(5):483-8.

    Questions and answers about carotid endarterectormy. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov . Accessed January 12, 2009.

    6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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