Carotid Endarterectomy

What is it ?

A carotid endarterectomy is a procedure in which a surgeon removes a blockage in a carotid artery. There are two carotid arteries, one on each side of the neck. These blood vessels bring blood to the brain and eyes. A blockage is usually a combination of cholesterol and calcium, called plaque, which builds up in carotid artery.

The buildup of plaque can partially or fully block the flow of blood. When the carotid artery is narrowed or blocked, blood flow to brain may be decreased. When the blood flow to brain is decreased, one may become dizzy or faint, experience problems with eyesight in one eye, or have numbness or weakness in one arm and leg.

• Because there is a blockage in the carotid artery, one may also have the same type of condition in the heart or other blood vessels
• This increases the risk of a heart attack during the operation.
• It is possible for nerves in the neck to be injured, causing weakness of your voice box, speech function, or tongue muscles
• One may have changes in blood pressure after the procedure. This is usually temporary.
• There is a possibility of a stroke during the operation or during the recovery period.

Why is it done?

A carotid endarterectomy is usually done when the carotid artery is more than 70% blocked. If the artery is not treated, one is at risk of having a major stroke. When the blockage is less than 70%, some alternatives to this procedure include:

• taking aspirin or other medicines that thin your blood
• choosing not to have treatment, recognizing the risks of your condition

How is it done?

The procedure could be done under general anesthetic or a regional anesthetic called a neck nerve block. A general anesthetic will relax muscles, puts the patient in deep sleep, but recovery is prolonged. With the neck block, patient is awake but will feel no pain. The surgeon makes a cut (incision) in neck and exposes the artery. A cut is made in the artery and atherosclerotic plaque, the blockage is removed.

The surgeon then repairs the artery and closes the incision in neck with stitches.

When it is done/advised ?

There are two types of carotid artery stenosis:

• Symptomatic carotid artery stenosis:
  This refers to narrowing of the carotid artery that is brought to medical attention by occurrence of transient ischemic attacks or previous strokes.

• Asymptomatic stenosis:
  This refers to narrowing of the carotid artery that is discovered incidentally without any obvious symptoms. For e.g. it is found during a routine physical examination, when the physician hears a sound with the stethoscope placed on the neck vessels, which is caused by blood flowing past the narrowing.

Preparation

Eat a light meal the night before the procedure and to not eat or drink anything after midnight before the procedure. Those taking other medicines, should specifically ask the physician whether such medicine should be taken, quite often one could take them on the day of surgery with a sip of water.

After

Call your Doctor if:

• You have trouble speaking or moving any part of your body.
• You lose your memory or have vision problems.
• You feel weak.
• You have difficulty breathing.
• You develop a fever.