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Decision Assist

Carotid artery surgery

Introduction

The purpose of this tool is to help you decide whether or not to have carotid artery surgery. When making a decision like this, you must balance:

  • The reasons for having the procedure
  • The potential health risks, drawbacks, or limitations of the procedure
  • Whether there are alternative procedures that may be more appropriate
  • Cost

This tool is not a substitute for professional medical care and advice. Work with your doctor to help you make this decision. A second opinion from another doctor may be valuable. There is usually no exact “right” or “wrong” answer.

Your physician may make certain recommendations to you. However, the final decision about whether to have this procedure rests with you.

What is the surgery?

The carotid arteries in your neck are a major source of blood flow to the brain. Carotid artery surgery is a surgical procedure to restore adequate blood flow to the brain when a carotid artery is partially blocked.

Endarterectomy

The procedure may be used to treat symptoms of carotid artery blockage, such as:

  • Weakness of the arm, leg, or face on one side of the body
  • Inability to move the arm, leg, or face on one side of the body (paralysis)
  • Numbness, tingling, or noticeable change in the sensation of the arm, leg, or face on one side of the body
  • Loss of all or part of vision (blindness) in one eye
  • Slurred speech or inability to speak
  • Past stroke with complete recovery
  • A mini-stroke, or TIA, that does not go away within 24 hours

The procedure may also be used to treat patients with severe blockage without symptoms.

The main type of carotid artery surgery is carotid endarterectomy. Carotid endarterectomy is a surgical procedure that cleans out and opens up the narrowed carotid artery.

Carotid artery surgery - series
Click the icon to see an illustrated series detailing carotid artery surgery.

Key points

  • Surgery may be done for those who have carotid artery blockages of 50 - 99%. The more this blockage cuts off blood flow through the carotid artery, the more likely your doctor will suggest you have surgery.
  • Surgery may reduce your risk of having a stroke.
  • Surgery may reduce your risk of having one or more mini-strokes (transient ischemic attacks, or TIA).
  • Surgery may reduce your risk of stroke-related death.
  • During and right after surgery, you risk of heart attack, stroke, and death may increase. Fortunately, this risk is usually small.
  • If you need carotid artery surgery, make sure the surgeon has done many of these procedures.
  • If you need carotid artery surgery, make sure the hospital has low complication rates (usually less than 6%).
  • There is a small risk of damage to the nerve that allows you to stick out your tongue.
  • Carotid artery surgery may help prevent further brain damage and reduce your risk of stroke. However, unless you make lifestyle changes (such as diet and exercise when approved by your doctor), plaque buildup, clot formation, and other problems in the carotid arteries can return.

How much time this decision tool will take

  • 5 - 10 minutes

What this tool will provide

  • A personalized list of factors for you to weigh
  • Questions to ask your doctor
  • Alternatives to this procedure
  • Recommended reading

Review Date: 12/31/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Previously reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Previously reviewed by J.A. Lee, MD, Division of Surgery, UCSF, San Francisco, CA (6/6/2008).


References:
  • Carotid endarterectomy -- an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. September 27, 2005;65(6):794-801.
  • Goldstein LB. Prevention and management of stroke. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 58.
  • Ringleb PA, Chatellier G, Hacke W, Favre JP, Bartoli JM, Eckstein HH, et al. Safety of endovascular treatment of carotid artery stenosis compared with surgical treatment: a meta-analysis. J Vasc Surg. 2008 Feb;47(2):350-5.
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