Carotid artery surgery

Definition

Carotid artery surgery is a procedure to restore proper blood flow to the brain.

The carotid artery brings needed blood to your brain and face. You have one of these arteries on each side of your neck. Blood flow in this artery can become partly or totally blocked by fatty material called plaque. This can reduce the blood supply to your brain and cause a stroke.

There are two procedures to treat a carotid artery that has plaque buildup in it. This article focuses on a surgery called endarterectomy. The other method is called angioplasty with stent placement.

Alternative Names

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

Description

During carotid endarterectomy:

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%.

If you have had a stroke or temporary brain injury, 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:

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

Risks

Risks of anesthesia are:

Risks of carotid surgery are:

Before the Procedure

Your doctor will do a thorough physical exam and order several medical tests.

Tell your health care provider what medicines you are taking, even medicines, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

Follow instructions on when to stop eating and drinking before surgery.

On the day of your surgery:

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.

Follow instructions on how to take care of yourself at home.

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. It is also important to stop smoking.

References

Arnold M, Perler BA. Carotid artery. In: Cronenwett JL, Johnston KW, eds. Rutherford's Vascular Surgery. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 100.

Biller J, Ruland S, Schneck MJ. Ischemic cerebrovascular disease. In Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. Philadelphia, PA: Elsevier; 2016:chap 65.

Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Catheter Cardiovasc Interv. 2013;81(1):E76-E123. PMID: 23281092 www.ncbi.nlm.nih.gov/pubmed/23281092.

Brott TG, Howard G, Roubin GS, et al. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021-1031. PMID: 26890472 www.ncbi.nlm.nih.gov/pubmed/26890472.

Perler BA. Carotid endarterectomy. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:937-941.