Carotid endarterectomy

Overview

Carotid endarterectomy is a surgical procedure designed to address carotid artery disease, a condition where fatty and waxy deposits accumulate in one of the carotid arteries located on either side of the neck. This buildup, known as atherosclerosis, can limit blood flow to the brain, posing a potential risk for stroke. The goal of the surgery is to improve blood flow by removing the obstructing plaque.

During the procedure, patients are given either a local or general anesthetic. The surgeon then makes an incision in the front of the neck, accesses the affected carotid artery, and carefully removes the plaque buildup. After the plaque is cleared, the artery is repaired either using stitches or by applying a patch graft, which can be crafted from a vein or synthetic material.

An alternative technique to the traditional method is the eversion carotid endarterectomy. In this method, the surgeon cuts the carotid artery and everts, or turns it inside out, to extract the plaque. Once the artery is cleaned, it is reattached to ensure normal blood flow.

Reason for undergoing the procedure

Your healthcare provider might recommend a carotid endarterectomy if you have significant plaque buildup in your carotid artery or if you’re experiencing issues with insufficient blood flow to your brain. This surgical procedure is aimed at removing the plaque, restoring proper blood flow, and reducing the risk of a stroke. The decision to undergo this surgery will be made in consultation with your healthcare provider, and a vascular surgeon typically performs it in a hospital surgical suite.

A carotid endarterectomy may be suggested if you meet the following criteria:

• You have been diagnosed with carotid artery disease.
• You’ve had a transient ischemic attack (TIA) or a mild stroke attributed to significant carotid artery disease.
• You have a severe narrowing or blockage in your carotid artery, typically around 80% or more, even if you haven’t experienced symptoms related to this condition.

If carotid endarterectomy is not suitable for your situation, your healthcare provider may recommend annual monitoring of your carotid artery. You might be advised to make dietary changes to lower your cholesterol levels and begin taking blood thinners like aspirin or clopidogrel to reduce the risk of stroke. Alternatively, your provider may consider performing an angioplasty to improve blood flow by pushing plaque against your carotid artery walls and placing a stent (a mesh tube) to keep the artery open.

Before the procedure

In preparation for your upcoming surgery, your healthcare provider may schedule some tests a few days beforehand to ensure your safety. One of these tests is a cerebral angiogram, which is an invasive procedure using X-rays to create images of the blood vessels inside your brain. However, in many cases, your healthcare provider may opt for noninvasive methods such as computed tomography (CT) angiography or magnetic resonance angiography (MRA) to gather the same information about your carotid arteries and brain without the risk of a stroke.

Before your carotid endarterectomy, it’s essential to communicate all the medications you are taking, including nonprescription drugs, herbs, and supplements, to your healthcare provider. They will provide specific instructions to help you prepare for the procedure. Most individuals will continue taking aspirin during the procedure, but it’s crucial to consult with your healthcare provider before discontinuing aspirin or clopidogrel if you are using these medications.

During the procedure

A carotid endarterectomy typically lasts around two hours. During this procedure, your healthcare provider will administer either general anesthesia, which will render you completely unconscious, or regional anesthesia, where you’ll remain awake but the surgical area will be numbed. If you receive regional anesthesia, you will also be given medication to help you relax.

The steps of a carotid endarterectomy are as follows:

• The surgeon makes an approximately 4-inch incision in your neck at the location of the blockage.
• In some cases, a small tube may be used to temporarily redirect blood flow around the blocked or narrowed area, isolating it.
• An incision is made along the portion of the carotid artery that contains the plaque buildup.
• The surgeon removes the plaque and then closes the incision, often using a patch of material to widen the artery and prevent future narrowing.
• Normal blood flow to the brain is restored through its usual pathway.

After the procedure

After the procedure, most individuals typically spend a night in the hospital for postoperative monitoring. Some patients may have a temporary drain in their neck to facilitate the removal of incision site fluid, typically removed after one day. Your healthcare provider will later discuss the procedure’s results with you. In most cases, this intervention aids in preventing additional brain damage and lowering the risk of strokes. However, it’s crucial to note that without adopting a healthier lifestyle, issues such as plaque accumulation, clot formation, and other carotid artery-related problems may recur.

Outcome

Recovery from a carotid endarterectomy is typically rapid, with most individuals being discharged the day following the procedure. Once at home, you can shower, but it’s important not to scrub the surgical glue or allow a direct stream of water to impact it. It’s advisable to inspect your incision daily and avoid applying any lotions to it, as well as refraining from wearing clothing that may rub against the incision. You can generally resume most of your regular activities within three to four weeks, and driving is permissible once your incision has healed and turning your head feels comfortable. However, it’s worth noting that the area around your jawline and earlobe may remain numb for a period ranging from six months to a year.