What is carotid endarterectomy?

Carotid endarterectomy is an operation that removes the inner lining of your carotid artery. This procedure eliminates a substance called plaque from your artery.
As you age, plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your carotid arteries, or cause irregularities in the normally smooth inner walls of the arteries.

Your carotid arteries are located on each side of your neck and extend from your aorta in your chest to the base of your skull. These arteries supply blood to your brain.

Carotid artery disease is a serious issue because clots can form on the plaque. Plaque or clots can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to your brain, it can cause an ischemic stroke, which can cause brain damage or death. If a clot or plaque blocks a tiny artery in the brain, it may cause a transient ischemic attack, also known as a mini-stroke.

To remove plaque in your carotid arteries and help prevent a stroke, your physician may recommend a carotid endarterectomy. Carotid endarterectomy is one of the most commonly performed vascular operations, and is a safe, well-established and long-lasting treatment.

 What are the symptoms?

• Carotid artery disease may not cause symptoms in its early stages.
• Unfortunately, the first sign of carotid artery disease could be a stroke.
• However, you may experience warning symptoms of a stroke called transient ischemic attacks, or TIAs. Symptoms of a TIA usually last for a few minutes to 1 hour and include:
 • Feeling weakness, numbness, or a tingling sensation on one side of your body,    for example, in an arm or a leg
 • Being unable to control the movement of an arm or a leg
 • Losing vision in one eye (many people describe this sensation as a window    shade coming down)
 • Being unable to speak clearly
• These symptoms usually go away completely within 24 hours. However, you should not ignore them.
• Having a TIA means that you are at serious risk of a stroke in the near future. You should report TIA symptoms to your physician immediately.

If you experience the above symptoms for longer than a few hours, or they don't resolve within 24 hours, a stroke has probably occurred. You should contact your physician immediately.

Am I a candidate for carotid endarterectomy?

You are eligible for the procedure if you have severe narrowing of your carotid arteries, especially if you are experiencing transient ischemic attacks and are in reasonably good health otherwise. You may be eligible, but at a relatively increased risk, if you have:

• Had a large stroke without recovery
• Widespread cancer with a life expectancy of less than 2 years
• High blood pressure that has not been adequately controlled by lifestyle changes or medications
• Unstable angina (chest pains)
• Had a heart attack in the last 6 months
• Congestive heart failure
• Signs of progressive brain disorders, such as Alzheimer's disease

What can I expect?

Your physician or vascular surgeon will give you the instructions you need to follow before the surgery, such as fasting.
Before your vascular surgeon performs a carotid endarterectomy, he or she may want to determine how much plaque has built up in your arteries. The most common test used for this purpose is duplex ultrasound. Duplex ultrasound uses high-frequency sound waves to show your blood vessels and measure how fast your blood flows.

Other tests your vascular surgeon may use include:

• Angiography
• Magnetic Resonance Angiography (MRA)
• CT scan

• Once you are asleep, your surgeon will shave the skin on your neck where he or she is going to make an incision, to help prevent infections.

• Your surgeon then makes the incision on one side of your neck to expose your blocked carotid artery.

• Your surgeon then temporarily clamps your carotid artery to stop blood from flowing through it. During the procedure, your brain receives blood from the carotid artery on the other side of your neck. Alternatively, your surgeon can insert a shunt to detour the blood around the artery that is being repaired.

• After your surgeon clamps your carotid artery, he or she makes an incision directly into the blocked section.

• Next, your surgeon peels out the plaque deposit by removing the inner lining of the diseased section of your artery containing the plaque.

• After removing the plaque, your surgeon stitches your artery, removes the clamps or the bypass, and stops any bleeding. He or she then closes your neck incision and the procedure is complete. Sometimes, a patch is used to widen the artery.

• The procedure lasts for about 2 hours. 

After the procedure:

• You may stay in the hospital for 1 to 2 days. During this time, your physician will monitor your progress.  Initially, during your recovery, you will receive fluid and nutrients through a small, thin tube called an intravenous (IV) catheter.

•  Because the neck incision is so small, you may not feel significant pain.

• After you go home, your physician may recommend that you avoid driving and limit physical activities for several weeks. You can usually begin normal activities again several weeks after the operation.

• If you notice any change in brain function, severe headaches, or swelling in your neck, you should contact your physician immediately.

Are there any complications?

• You may have complications following any surgical procedure.

• A stroke is one possible complication following a carotid endarterectomy. This risk is very low, ranging between 1 and 3 percent.

•  Another unusual complication is the re-blockage of the carotid artery, called restenosis that may occur later, especially if you continue to smoke cigarettes.

• Temporary nerve injury, where you might experience numbness in your face or tongue, is another uncommon, but possible, complication. This usually clears up in less than 1 month and usually doesn't require any treatment.