What is carotid endarterectomy?
It is an operation where a vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates plaque from your artery and can restore blood flow, which decreases your chances of heart attack or stroke.
Why is plaque dangerous? Why remove plaque?
As you age, plaque can build up in the walls of your arteries. It is made up of cholesterol, calcium, and fibrous tissue. You want it removed because as more plaque builds up, your arteries narrow and stiffen. (This is called atherosclerosis) If enough plaque builds up it will reduce blood flow through your carotid arteries, or cause irregularities in the normally smooth inner walls of the arteries.
Your carotid arteries supply blood to your brain. And because of their role, carotid artery disease is a serious issue. Clots can form on the plaque. If a clot or plaque blocks the blood flow to your brain sufficiently, it can cause an ischemic stroke, which can cause permanent brain damage, or death. Thus, if you have too much plaque buildup in your carotid artery, a carotid endarterectomy may be what your doctor reccommends. Carotid endarterectomy is one of the most commonly performed vascular operations, and is a safe and long-lasting treatment.
So, should you be getting one, how do you prepare?
How you will prepare will depend on your case and your doctor or physician. Your physician or vascular surgeon will give you the instructions you need to follow before the surgery, such as fasting.
How do I know if I need this?
In order to determine how much plaque has built up in your arteries. The most common test used for this purpose is duplex ultrasound. Duplex ultrasound uses painless sound waves to show your blood vessels and measure how fast your blood flows. Duplex ultrasound is a method that can also determine the location and degree of narrowing in your carotid artery.
How do you know if you are eligible for carotid endarterectomy?
You are eligible for the procedure if you have severe narrowing of your carotid arteries, especially if you are experiencing TIA’s (similar symptoms as stroke, but not as long lasting) and are in reasonably good health otherwise.
How do I know if I am at risk during carotid endarterectomy?
You may have a relatively increased risk, if you have:
1. Had a large stroke without recovery
2. Widespread cancer with a life expectancy of less than 2 years
3. High blood pressure that has not been adequately controlled by lifestyle changes or medications
4. Unstable angina (chest pains)
5. Had a heart attack in the last 6 months
6. Congestive heart failure
7. Signs of progressive brain disorders, such as Alzheimer’s disease
What happens during the actual surgery for a carotid endarterectomy?
There are two ways you can have this surgery, you can either be put to sleep or, the surgeon can numb your neck area and keep you awake so you can communicate with the surgeon during the operation.
Is one way better than the other?
There are benefits to staying awake because by staying awake, you may help your physician monitor your brain’s reaction to the decreased blood supply.
So what happens next?
Once you are either asleep or the area around your neck is completely numb, the surgeon shaves the skin where he or she will make an incision, in order to help prevent infections. Your surgeon then makes the incision on one side of your neck to expose your blocked carotid artery. Your carotid artery will be temporarily clamped to stop blood from flowing through it. But do not worry, your brain will still get blood from the carotid artery on the other side of your neck.
After the artery is clamped the surgeon makes an incision directly into the blocked section. Next, your surgeon peels out the plaque deposit by removing the inner lining of the diseased section of your artery containing the plaque. Then you get stitched back up. Sometimes, a patch is used to widen the artery. The patch material used can be your own vein, which is usually from the leg, or can be any one of a variety of synthetic materials.
How long does it take?
The procedure takes about 2 hours to perform but may seem slightly longer depending upon the anesthetic and preparation time. .
What happens after a carotid endarterectomy?
After surgery, you usually have to stay in the hospital for 1 to 2 days so that your physician can monitor your progress. At first you will receive fluid and nutrients through intravenous (IV) catheter. Because the neck incision is so small, you should not feel significant pain.
After you go home, there are some activities you should avoid for a while. It is usually recommend that you avoid driving and limit physical activities for several weeks.