Carotid artery surgery
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. Such a blockage can reduce the blood supply to your brain and may 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.
Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery
During carotid endarterectomy:
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:
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:
Carotid angioplasty and stenting is more likely to be used when carotid endarterectomy would not be safe.
The risks for any anesthesia are:
The risks for any surgery 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 drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
Do NOT drink anything after midnight the night before your surgery, including water.
On the day of your surgery:
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.
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.
International Carotid Stenting Study Investigators. Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010;375:985-997.
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: W.B. Saunders; 2011:chap 62.
Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010 Jul 1;363(1):11-23. Epub 2010 May 26.
Goldstein LB, Bushnell CD, Adams RJ. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517-584.
Rerkasem K, Rothwell PM. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database of Syst Rev. 2011;4:CD001081. DOI: 10.1002/14651858.CD001081.pub2.
Review Date: 6/4/2012
Reviewed By: Shehzad Topiwala, MD, Chief Consultant Endocrinologist, Premier Medical Associates, The Villages, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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