What is Carotid Endarterectomy? Purpose, Procedure & Results

Carotid endarterectomy is a surgical procedure that removes plaque buildup from your carotid arteries. These are the major blood vessels in your neck that carry oxygen-rich blood to your brain. When plaque narrows these arteries, it can increase your risk of stroke, and this surgery helps restore proper blood flow to protect your brain.

What is carotid endarterectomy?

Carotid endarterectomy is a preventive surgery that cleans out your carotid arteries. Think of it like clearing a clogged pipe - your surgeon removes the fatty deposits and plaque that have built up on the artery walls over time.

This procedure specifically targets carotid artery stenosis, which means narrowing of these critical blood vessels. The surgery involves making a small incision in your neck, temporarily opening the artery, and carefully scraping away the plaque buildup.

The goal is to widen the artery back to its normal size so blood can flow freely to your brain. This dramatically reduces your risk of having a stroke caused by blocked blood flow or pieces of plaque breaking off.

Why is carotid endarterectomy done?

Your doctor recommends this surgery primarily to prevent strokes. When your carotid arteries become significantly narrowed - usually by 70% or more - the risk of stroke increases substantially.

The procedure is most commonly performed when you have severe carotid artery disease but haven't yet had a major stroke. It's also recommended if you've experienced mini-strokes (called transient ischemic attacks or TIAs) or if imaging tests show dangerous plaque buildup.

Sometimes doctors recommend this surgery even if you don't have symptoms, especially if tests reveal very tight narrowing. The surgery works as a protective measure, like fixing a dam before it breaks rather than waiting for a flood.

What is the procedure for carotid endarterectomy?

The surgery typically takes 2-3 hours and is performed under general anesthesia, so you'll be completely asleep. Your surgeon makes a 3-4 inch incision along the side of your neck to access the carotid artery.

Here's what happens during the main steps of the procedure:

1. Your surgeon carefully separates the muscles and tissues to reach the carotid artery
2. They place temporary clamps above and below the narrowed section to stop blood flow
3. A small tube (shunt) may be inserted to maintain blood flow to your brain during the procedure
4. The artery is opened lengthwise, and the plaque is meticulously removed in one piece when possible
5. The artery is closed with fine stitches, sometimes using a patch to widen it
6. Blood flow is restored, and the incision is closed in layers

Your surgical team monitors your brain function throughout the procedure using various techniques. Most patients can return home within 1-2 days after surgery.

How to prepare for your carotid endarterectomy?

Your preparation begins about a week before surgery with specific instructions from your medical team. You'll need to stop certain medications, particularly blood thinners, as directed by your doctor.

Your pre-surgery preparation typically includes:

• Stopping smoking at least 2 weeks before surgery to improve healing
• Arranging for someone to drive you home and stay with you for 24 hours
• Avoiding food and drinks after midnight before your surgery day
• Taking any prescribed medications with a small sip of water as instructed
• Bringing a list of all your current medications to the hospital
• Wearing comfortable, loose-fitting clothes that don't need to go over your head

Your doctor may also order additional tests like blood work or imaging studies to ensure you're ready for surgery. Don't hesitate to ask questions about anything that concerns you.

How to read your carotid endarterectomy results?

Success after carotid endarterectomy is measured by improved blood flow and reduced stroke risk. Your doctor will use ultrasound tests to check that your artery is now wide open and blood is flowing smoothly.

Immediately after surgery, you can expect some swelling and discomfort at the incision site. Your neck may feel tight or numb for several weeks, which is completely normal as tissues heal.

Long-term results are generally excellent - studies show the surgery reduces stroke risk by about 50% in appropriate candidates. Most people experience no ongoing symptoms and can return to their normal activities within 2-4 weeks.

Your medical team will schedule follow-up appointments to monitor your recovery and ensure the artery stays open. These check-ups are crucial for maintaining your good results.

What are the risk factors for needing carotid endarterectomy?

Several factors increase your likelihood of developing carotid artery disease that might require this surgery. Age is the most significant factor, with risk increasing substantially after 65.

The primary risk factors that contribute to carotid artery narrowing include:

• High blood pressure that damages artery walls over time
• High cholesterol levels that lead to plaque formation
• Diabetes, which accelerates artery damage
• Smoking, which doubles your risk of carotid artery disease
• Family history of heart disease or stroke
• Previous heart attack or peripheral artery disease
• Obesity and sedentary lifestyle

Having multiple risk factors compounds your chances of developing significant carotid artery disease. The good news is that many of these factors can be managed through lifestyle changes and medications.

What are the possible complications of carotid endarterectomy?

While carotid endarterectomy is generally safe, like any surgery, it carries some risks. The most serious potential complication is stroke, which occurs in about 1-3% of patients.

Other possible complications, though uncommon, include:

• Heart attack due to the stress of surgery
• Bleeding or blood clot formation at the surgical site
• Infection of the incision, usually treatable with antibiotics
• Nerve damage causing temporary or permanent voice changes
• Temporary difficulty swallowing or facial weakness
• Blood pressure changes that require medication adjustments

Most complications are temporary and resolve within weeks to months. Your surgical team takes extensive precautions to minimize these risks, and the benefits typically far outweigh the potential complications.

Rare complications might include seizures or cognitive changes, but these affect less than 1% of patients. Your surgeon will discuss your specific risk profile before the procedure.

When should I see a doctor after carotid endarterectomy?

You should contact your doctor immediately if you experience any stroke symptoms after surgery. These include sudden weakness, numbness, confusion, trouble speaking, or severe headache.

Other warning signs that require prompt medical attention include:

• Excessive bleeding or swelling at the incision site
• Signs of infection like fever, increasing pain, or pus from the incision
• Sudden changes in vision or dizziness
• Difficulty breathing or chest pain
• Severe neck pain or stiffness
• New numbness or tingling in your face or limbs

For routine follow-up, you'll typically see your surgeon within 1-2 weeks after surgery. Regular check-ups with ultrasound tests are usually scheduled at 6 months, then annually to monitor your artery.

Don't worry about minor discomfort, bruising, or slight swelling - these are normal parts of healing. When in doubt, it's always better to call your medical team with questions.