Patient education: Carotid endarterectomy (The Basics)

What is carotid artery disease? — Carotid artery disease is a condition that can increase a person's risk of having a stroke. It happens when fatty deposits called plaque build up inside blood vessels called the "carotid arteries." These are the 2 main blood vessels in the neck that bring blood to the brain. When plaque forms in these arteries, the arteries can narrow (figure 1).

One way to treat carotid artery disease is with a surgery called "carotid endarterectomy."

What is carotid endarterectomy? — Carotid endarterectomy is a surgery to remove plaque from the carotid arteries. This surgery is most often done for people who have had a recent transient ischemic attack ("TIA") or stroke.

This is an open surgery where the doctor makes a cut, or "incision," in the skin. This allows them to see directly inside the body when they do the surgery.

How do I prepare for carotid endarterectomy? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Ultrasound or other imaging tests – Imaging tests create pictures of the inside of the body. Some people with symptoms get brain imaging tests.

●Electrocardiogram ("ECG") - This test measures the heart's electrical activity.

●Exercise stress test – During this test, the doctor records your heart rate while you exercise on a treadmill or bike.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●Any neck surgery you have had – Examples include past carotid endarterectomy or thyroid surgery.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) any neck hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

●If you need to start taking medicine to prevent blood clots before surgery

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during carotid endarterectomy? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb your neck so you don't feel pain.

•Regional – This type of anesthesia blocks pain in your neck. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicine in the skin around the incision. This can help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure. If you have general anesthesia, your doctor will also monitor your brain during surgery.

●The doctor will make an incision in your neck and in the blocked carotid artery. Then, they will remove the plaque.

●The doctor might place an artificial "graft" to patch the artery. Or, they might use part of another blood vessel. This will help keep the artery from narrowing as it heals.

●The doctor will check the blood vessel carefully to make sure that there is no bleeding.

●Sometimes, the doctor will place a flexible tube or "drain" in your neck. This helps get rid of any extra fluid from around the surgery site.

●The doctor will close your incisions and cover them with clean bandages.

●This procedure usually takes 2 to 4 hours.

What happens after carotid endarterectomy? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people stay in the hospital for at least a day or so after surgery. Others stay longer.

As you recover:

●If you had general anesthesia, you might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●If you had a drain in your neck, it will be removed within a week or so.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of carotid endarterectomy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Stroke

●Heart attack

●Bleeding or blood clots

●Infection

●Too much blood flow to the brain ("hyperperfusion syndrome")

●Injury to nerves in the area

●The artery getting blocked again

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Carotid endarterectomy – Discharge instructions (The Basics)
Patient education: Carotid artery disease (The Basics)
Patient education: Stroke (The Basics)
Patient education: Transient ischemic attack (The Basics)
Patient education: High cholesterol (The Basics)
Patient education: Duplex ultrasound (The Basics)

Patient education: Stroke symptoms and diagnosis (Beyond the Basics)
Patient education: Transient ischemic attack (Beyond the Basics)
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