What to Expect from Carotid Endarterectomy

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Carotid endarterectomy is a procedure that removes plaque from the carotid artery in the neck in order to prevent stroke. The carotid arteries are two large blood vessels located in the neck that supply blood to the brain. A plaque in the neck is formed by a buildup of cholesterol, blood clots and debris that narrow the passageway for blood as it travels to the brain. When a blood vessel is narrowed by carotid plaque or carotid disease, this is called carotid stenosis.

A carotid plaque may cause a stroke if some of the material breaks off and blocks a blood vessel anywhere in the brain.

Carotid blood vessel plaques may first be noticed after you experience the warning signs of stroke, commonly referred to as TIA, or transient ischemic attack. It is important to note that TIA and stroke symptoms are generally only on one-side and can include arm, leg or face weakness, slurring of speech, an inability to form words, or even blindness in one eye. Often these symptoms may last for just a few minutes, followed by a complete recovery and disappearance of symptoms. However, TIA and a stroke are both emergencies, requiring immediate medical attention.

Nevertheless, most carotid plaques and carotid stenosis are actually picked up in patients who do not have any symptoms at all. Ultrasound in an accredited vascular lab is the most accurate, non-invasive, and cost-effective screening test.

Sometimes your doctor may order this test if she hears an abnormal "whooshing" sound in the neck with a stethoscope. Other times, the test is ordered if you have many risk factors for cardiovascular disease, such as smoking, high cholesterol, diabetes, high blood pressure or even a strong family history.

Medical research studies demonstrate that surgery for patients who have more than 70-80% stenosis of the carotid artery effectively reduces the lifetime risk of stroke in half (ACAS and ACST studies).

The surgery is painless because it is normally done under general anesthesia. Recovery begins after awaking from the procedure. On the evening after surgery, you can usually start to sit up and drink liquids. An ice pack is generally placed near the incision to reduce swelling. You can expect to rest overnight in a well-monitored setting. The next morning, you should be able to get up and walk, usually after eating a regular breakfast.  Most patients go home the day after surgery. At home, you can resume normal activity except for heavy lifting. Driving should be avoided for one to two weeks at the discretion of the surgeon. Numbness under the chin can be expected and ordinarily improves with time. Overall most patients can resume driving and all routine activities after the two-week follow up appointment.

 

Carotid endarterectomy is one of the most well studied surgical procedures and, in experienced hands, carries a very low complication rate. Additionally the majority of patients tolerate surgery well and make a quick recovery. 

Ironically, while treatment of carotid stenosis is designed to prevent stroke, the most concerning complication is, in fact, a stroke. An understanding of the best ways to perform the procedure has reduced complication rates significantly - currently well-trained, experienced and qualified vascular surgeons have reduced this complication to less than 1%. For example, an incision is made directly over the blood vessel and, if necessary, blood flow is diverted while the plaque is removed. 

Long-term, a follow up carotid ultrasound is recommended biannually. This is done to catch disease on the other side as well as scar tissue buildup within the artery that underwent surgery. Nevertheless, less than one in ten patients develop a significant re-narrowing in their lifetime.

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