Carotid artery surgery

Description

During carotid endarterectomy:

• You will probably receive general anesthesia. You will be asleep and pain-free. Some hospitals may use local anesthesia instead. Only the part of your body being worked on will be numbed with medicine so that you will not feel pain. You will be given a medicine to help you relax.
• You will lie on your back on a padded operating table with your head turned to one side. The side your blocked carotid artery is on will face up.
• Your surgeon will make a surgical cut on your neck over your carotid artery. Your surgeon will put a catheter (a flexible tube) in place. Blood will flow through the catheter around the blocked area during surgery.
• Then your surgeon will open your carotid artery. The surgeon will remove the plaque inside your artery.
• Your artery will be closed up with stitches after the plaque is removed. Blood will now flow through the artery to your brain.
• Your heart and brain activity will be monitored closely during your surgery.

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:

• Narrowed by more than 70%
• Narrowed between 50% and 70% and your doctor thinks you have a very high risk of having a stroke

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:

• No treatment, other than tests to check your carotid artery every year
• Medicine and diet to lower your cholesterol
• Blood-thinning medicines to lower your risk of stroke. Some of these medicines are aspirin, clopidogrel (Plavix), and warfarin (Coumadin).

Carotid angioplasty and stenting is more likely to be used when carotid endarterectomy would not be safe.

Risks

The risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

The risks for any surgery are:

• Bleeding
• Infection

Risks of carotid surgery are:

• Blood clots or bleeding in the brain
• Brain damage
• Heart attack
• More blockage of the carotid artery over time
• Seizures (this is rare)
• Stroke (this is rare)
• Swelling near your airway (the tube you breathe through)

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:

• A few days before the surgery, you may need to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, you need to stop. Ask your doctor or nurse for help quitting.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

Do NOT drink anything after midnight the night before your surgery, including water.

On the day of your surgery:

• Take any drugs your doctor prescribed with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

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.

Outlook (Prognosis)

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.

Alternative Names

Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery

References

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.

Update Date: 6/4/2012

Updated 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.