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Operations can restore your health and even save your life, but it is normal to feel a bit anxious about “going under the knife”, especially the day or two beforehand, which are often spent in the hospital preparing for the operation. Today, more operations are done as day surgery. That means that people go to the hospital or practice, have the procedure and are then back home the same day.

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Carotid artery surgery

Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery

Last reviewed: May 15, 2013.

Carotid artery surgery is a procedure to restore proper blood flow to the brain.

The carotid artery brings needed blood to your brain and face. You have one of these arteries on each side of your neck. Blood flow in this artery can become partly or totally blocked by fatty material called plaque. This can reduce the blood supply to your brain and cause a stroke.

There are two invasive ways to treat a carotid artery that has plaque buildup in it. This article focuses on a surgery called endarterectomy. The other method is called angioplasty with stent placement.

Description

During carotid endarterectomy:

  • You receive general anesthesia. You are asleep and pain-free. Some hospitals use local anesthesia instead. Only the part of your body being worked on is numbed with medicine so that you do not feel pain. You will be given a medicine to help you relax.
  • You lie on your back on an operating table with your head turned to one side. The side your blocked carotid artery is on faces up.
  • The surgeon makes a cut (incision) on your neck over your carotid artery. A flexible tube (catheter) is put in place. Blood flows through the catheter around the blocked area during surgery.
  • Your carotid artery is opened. The surgeon removes the plaque inside the artery.
  • After the plaque is removed, the artery is closed with stitches. Blood now flows through the artery to your brain.
  • Your heart and brain activity will be monitored closely during surgery.

The surgery takes about 2 hours. After the procedure, your doctor may do a test to confirm that the artery has been opened.

Why the Procedure Is Performed

This procedure is done if your doctor has found narrowing or a blockage in your carotid artery. Your doctor will have done one or more tests to see how much the carotid artery is blocked.

Surgery to remove the buildup in your carotid artery may be done if the artery is:

  • Narrowed by more than 70%
  • Narrowed between 50% and 70% and your doctor thinks you have a very high risk of having a stroke

If you have had a stroke, your doctor will consider whether treating your blocked artery with surgery is safe for you.

Other treatment options your doctor will discuss with you are:

  • No treatment, other than tests to check your carotid artery every year
  • Medicine and diet to lower your cholesterol
  • Blood-thinning medicines to lower your risk of stroke. Some of these medicines are aspirin, clopidogrel (Plavix), and warfarin (Coumadin).

Carotid angioplasty and stenting is more likely to be used when carotid endarterectomy would not be safe.

Risks

Risks for any of anesthesia are:

Risks of carotid surgery are:

Before the Procedure

Your doctor will do a thorough physical exam and order several medical tests.

Always tell your doctor or nurse what medicines you are taking, even medicines, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

  • A few days before the surgery, you may need to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
  • Ask your doctor which medicines you should still take on the day of your surgery.
  • If you smoke, you need to stop. Ask your doctor or nurse for help quitting.
  • Tell your doctor about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

Do not drink anything after midnight the night before your surgery, including water.

On the day of your surgery:

  • Take any medicines your doctor prescribed with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

You may have a drain in your neck that goes into your incision. It will drain fluid that builds up in the area. It will be removed within a day.

After surgery, your doctor may want you to stay in the hospital overnight so that nurses can watch you for any signs of bleeding, stroke, or poor blood flow to your brain. You may be able to go home the same day if your operation is done early in the day and you are doing well.

Outlook (Prognosis)

Carotid artery surgery may help lower your chance of having a stroke. But you will need to make lifestyle changes to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. You may need to change your diet and start an exercise program, if your doctor tells you exercise is safe for you.

References

  1. Goldstein LB. Prevention and management of stroke. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 62.
  2. Silva MB Jr., Choi L, Cheng CC. Peripheral arterial occlusive disease. In: In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 63.
  3. Society for Vascular Nursing. 2009 Clinical practice guideline for patients undergoing carotid endarterectomy (CEA). J Vasc Nurs. 2010;28:21-46. [PubMed: 20185077]

Review Date: 5/15/2013.

Reviewed by: John A. Daller, MD, PhD., Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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What works?

  • Carotid endarterectomy for carotid stenosis in patients selected for coronary artery bypass graft surgeryCarotid endarterectomy for carotid stenosis in patients selected for coronary artery bypass graft surgery
    People who have coronary artery disease requiring coronary artery bypass graft (CABG) surgery often have narrowing of other arteries. If the carotid artery, the artery carrying blood to the brain, is narrow (called carotid stenosis), this may increase the risk of stroke and other brain damage, complicating CABG surgery. Surgery to remove the carotid narrowing might prevent these complications of CABG surgery, but also has risks. We found no reliable evidence from randomised trials to indicate whether or not to perform preventive carotid surgery in patients who are going to have CABG surgery.
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Figures

  • Carotid stenosis, x-ray of the left artery.
    Carotid stenosis, x-ray of the right artery.
    Blockage in internal carotid artery.
    Atherosclerosis of internal carotid artery.
    Arterial plaque build-up.

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