What is a carotid endarterectomy?

A carotid endarterectomy is a procedure in which the doctor removes a blockage in the carotid artery. The carotid arteries are the two blood vessels in the neck that bring blood to the brain. The blockage is usually a combination of cholesterol and calcium, called plaque, which has built up in your artery. The buildup of plaque can partially or fully block the flow of blood. When this artery is narrowed or blocked, blood flow to your brain is decreased.

When is it used?

When the blood flow to your brain is decreased, you may become dizzy or faint, experience problems with eyesight in one eye, or have numbness or weakness in one arm and leg. A carotid endarterectomy is performed to clear the carotid artery. If the artery is left untreated, you are at risk of having a major stroke.

Some alternatives to this procedure include:

• taking aspirin or other medications that thin your blood

• choosing not to have treatment, recognizing the risks of your condition.

You should ask your doctor about these choices.

How do I prepare for a carotid endarterectomy?

Follow the instructions provided by your doctor. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Allow for time to rest after the surgery and try to find people to help you with your day-to-day duties.

What happens during the procedure?

You will be given a general anesthetic or a regional anesthetic called a neck nerve block. A general anesthetic will relax your muscles, put you in a deep sleep, and prevent you from feeling pain during the operation. With the neck block, you will be awake but will feel no pain.

The doctor makes a cut (incision) in your neck and exposes the artery. A cut is made in the artery and the blockage is removed. The doctor then repairs the artery and closes the incision in your neck with stitches.

What happens after the procedure?

At first you will stay in an intensive care unit or special care postoperation unit. When your condition is stable, you will be taken to a regular room. You may stay in the hospital 1 to 2 days, depending on your condition. You may need some form of medicine that makes the blood less likely to clot after the surgery. In a few weeks you may be able to return to a normal lifestyle.

Because you had plaque in your artery, you should eat less fat and try to exercise more after you have recovered from the procedure. Ask your doctor what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You may no longer have problems with your sight or feel a weakness or numbness in your arms or legs. In addition, you may avoid having a major stroke.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.

• The regional anesthetic (neck block) may not numb the area quite enough and you may feel some minor discomfort.

• Because there is a blockage in the carotid artery, you may also have the same type of condition in the heart or other blood vessels. This increases the risk of a heart attack during the operation.

• It is possible for nerves in the neck to be injured, causing weakness of the voice box, speech function, and/or tongue muscles.

• You may have changes in your blood pressure after the procedure. This is usually temporary.

• There is a possibility of a stroke during the operation or during the recovery period.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You have trouble speaking or moving any part of your body.

• You lose your memory or have vision problems.

• You feel weak.

• You develop a fever.

Call the doctor during office hours if:

• You have questions about the procedure or its result.

• You want to make another appointment.