Part UT Health San Antonio

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 mini-strokes and considered a warning sign for a future stroke.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Bleeding
  • Infection
  • Damage to the carotid artery
  • High blood pressure or low blood pressure
  • Stroke
  • Nerve injury in the neck

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
  • ECG —a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Imaging tests to assess the arteries include:

Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.

The night before, eat a light meal. Do not eat or drink anything after midnight.

Anesthesia

  • General anesthesia will keep you asleep during the procedure
  • Local anesthesia—the area will be numbed

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. A section of the carotid artery may need to be removed. 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

An arteriogram may be done to ensure that there are no complications, such as blood clots or narrowing. You may be given medication to help prevent blood clotting.

How Long Will It Take?

2-4 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

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

Post-procedure Care

At Home

It may take up to 2 weeks to recover. Slowly return to normal activity as tolerated. You may be referred to a dietitian who can help with dietary changes. These changes will help prevent a return of plaque build-up. Changes focus on a diet low in saturated fat. Make sure your diet is high in fruits, vegetables, grains, and fish.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Persistent nausea or vomiting
  • Pain that you cannot control with the medications you were 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
  • Lightheadedness or fainting

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

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

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

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

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

REFERENCES:

Stroke treatments. American Heart Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/Treatment/Stroke-Treatment_UCM_492017_SubHomePage.jsp#. Accessed November 30, 2017

Carotid endarterectomy. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/articles/carotid-endarterectomy. Accessed November 30, 2017.

Questions and answers about carotid endarterectomy. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Stroke-Hope-Through-Research/Questions-Answers-Carotid-Endarterectomy. Updated March 21, 2016. Accessed November 30, 2017.

6/2/2011 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use: 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.

Last reviewed November 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC  Last Updated: 12/20/2014