Carotid endarterectomy is a surgical procedure to restore blood flow through a narrowed or blocked carotid artery. The carotid arteries are the blood vessels in the neck that carry blood to the brain. Over time, these arteries, like all arteries in your body, can become diseased through build-up of a fatty substance called plaque, which is made up of cholesterol, calcium and other materials. Carotid endarterectomy is a well-proven treatment for carotid artery disease. It has been performed successfully for over 50 years. It can be an important therapy in preventing a first or recurrent stroke.
How Does Carotid Endarterectomy Work?
If diagnostic tests have revealed that you have a blockage in a carotid artery that is best treated by surgery, you may be treated with carotid endarterectomy. The procedure is performed by a vascular surgeon, a medical specialist trained in surgical procedures to treat conditions affecting the blood vessels. The surgery is performed through an incision in the neck. Plaque is removed from the inner lining of the diseased artery, thereby restoring blood flow through the artery to the brain.
What Can You Expect Before the Surgery?
Members of your care team will give you instructions about what to expect on the day of the surgery. The surgery is performed in a hospital’s operating room. Your vascular surgeon may choose to use either general anesthesia (“put you under” or asleep) or local anesthesia (numbing only the area where the incision will be made). Using local anesthesia can allow the surgeon to talk with you during the surgery and monitor blood flow to your brain.
What Can You Expect During the Surgery?
The surgery typically takes about 2 hours, though there will be additional preparation time before the procedure. During the surgery, the surgeon will make a small incision in your neck. He or she will then clamp the carotid artery to stop blood flow or will insert a tube called a shunt to create a “bypass” for the blood. Blood will continue to flow to your brain through the shunt as well as the carotid artery on the other side of your neck.
The surgeon will remove the inner lining of your carotid artery at the point of the blockage. Arteries have a smooth inner lining, called the endothelium, and plaque can become embedded in this lining. You may have heard the term “hardening of the arteries,” or atherosclerosis, to refer to this process. By removing a portion of this lining, the surgeon can remove the blockage.
The surgeon will then remove the shunt (if one was placed) and stitch the artery closed. Some patients may place a patch over the incision in the artery. The patch may be made from a vein from elsewhere in the body or from man-made materials. Finally, the surgeon will close the incision in your neck with stitches.
What Can You Expect After the Surgery?
Patients usually stay in the hospital for 1 to 2 days after the surgery to allow time for recovery and time for the physician to monitor progress.
You will be discharged with information about which activities you may need to limit and for how long, such as driving or physical activities. Normal activity can usually be resumed a few weeks after the surgery.
Your care team will notify you of warning signs that you should contact them, such as the following:
- Symptoms of a stroke, such as confusion and difficulty speaking or understanding speech, or numbness or weakness of the face or limbs on one side of the body
- Severe headaches
- Swelling in your neck
Does the Surgery Carry Risks?
Like all surgeries, carotid endarterectomy carries some risks, although serious complications are rare. The risks of the surgery are usually lower than those of not being treated for carotid artery disease. Talk with your physician about risks. Some risks include:
- Reblockage of the artery (restenosis)
- Nerve injury in the face or tongue
Long-Term Recovery from Carotid Endarterectomy
Your recovery from the carotid endarterectomy surgery will typically be brief, with discharge from the hospital taking place within a couple of days followed by about a week of recovery at home. However, recovering from the surgery is only the beginning of the process of preventing a future stroke, heart attack or other forms of cardiovascular disease. Lifestyle changes and taking medications exactly as prescribed by your physician can help slow, halt or reverse the underlying disease process that caused blockages in your carotid arteries and all of the arteries throughout your body.
Questions to Ask Your Doctor About Carotid Endarterectomy
You may wish to use the following questions as a tool to help you talk to your physician about carotid endarterectomy. We invite you to print them and take them with you to your next appointment. Taking notes may help you remember your discussion when you get home.
- Based on my risk factors, medical history and the severity and location of the blockages in my carotid arteries, what is the best treatment for me?
- What will I need to do in the weeks, hours and days leading up to the surgery? Are there tests that I will need to undergo?
- What else can I do to prepare for the surgery so that I have a successful surgery and recovery?
- How long will I be in the hospital?
- Considering my history, do you have concerns about complications?
- How long until I can return to work or other normal daily activities?
- How will I feel after recovery is complete?
- Will my arteries re-narrow or become blocked again? If so, in what time period should I expect this to happen?
- What kind of care is necessary and ongoing after the surgery? Do I have to keep taking medications? What kind and why?
- Can I get help with making lifestyle changes, such as quitting smoking, adopting a healthy diet and exercising?
You may have questions about why your physician may recommend either carotid endarterectomy or carotid angioplasty and stenting. This decision will be individualized to the severity and location of your blockages, your medical history and your risk factors. Click here for an introduction to some basic guidelines for one procedure or the other.
If you are scheduled to undergo carotid endarterectomy, it can be helpful to know who the medical professionals are who will treat you along the way. Click here to learn about your care team during carotid endarterectomy.