The carotid arteries are the main arteries that carry blood from the base of the neck to the brain. When plaque builds up on the inner wall of one of the carotid arteries it can decrease, or even stop, the flow of blood to the brain. This can result in a transient ischemic attack (TIA), also known as “mini-stroke,” or full-blown stroke.

• A TIA is a temporary blockage of blood flow to the brain. There is no permanent damage and the symptoms that occur are usually temporary. However, a TIA is a serious warning sign that a stroke might occur in the near future.
• A stroke results in the death of brain cells and varying amounts of disability.

A carotid endarterectomy involves the surgical removal of plaque from the inner wall of the carotid artery. The artery is accessed by making an incision on the affected side of the neck.

• A balloon may be used to open the narrowed artery.
• A stent may be inserted to help keep the artery open.

Some of the risk factors for developing a blockage of your carotid artery include:

• Family history of atherosclerosis (build-up of plaque in the peripheral, coronary, or carotid arteries)
• Age (Men have a higher risk before age 75 and women have a higher risk after age 75)
• Smoking and other use of tobacco products
• High blood pressure or other cardiovascular disease
• Diabetes
• Elevated cholesterol
• Obesity

If your lifestyle increases your risk of carotid artery disease, your doctor may make recommendations to decrease your risk. Some of the most frequently recommended lifestyle changes include:

• Stopping the use of all tobacco products
• Avoiding secondhand smoke
• Consuming a healthy diet
• Exercising regularly

Your healthcare provide may also recommend a cholesterol lowering medication called a “statin”.

If you have atherosclerosis of the carotid arteries, you may have atherosclerosis in arteries in another part of your body.

• This includes the coronary arteries that supply blood to your heart.
• You will need an evaluation to determine your risk for coronary heart disease and, if necessary, begin interventions that can reduce the risk.

Many factors will be considered before your healthcare provider recommends a carotid endarterectomy. These include:

• The extent of narrowing in your arteries (carotid and coronary)
• Your risk factors for a stroke
• Whether you have had symptoms of a TIA, which can signal an impending stroke
• Whether you have had a previous stroke

The symptoms of a stroke and TIA are similar. However, they do vary in severity and whether or not they are temporary (TIA) or permanent (stroke). The symptoms can include:

• Weakness
• Tingling, drooping, or numbness on one side of the body
• Vision loss in one eye
• Dizziness or lightheadedness
• Difficulty speaking or loss of speech
• Loss of balance or coordination
• Sudden and severe headache
• Confusion

To help people remember the signs and symptoms of a stroke, many organizations use the acronym FAST.> Face – does one side of the face droop when smiling?> Arms – does one arm drift downwards when both are held up?> Speech – does one's speech seem slurred or different?> Time – time is critical if someone has these symptoms.Time is critical when the blood flow to the brain has been decreased. Seek immediate medical attention if you experience symptoms of a stroke.

Your healthcare provider may recommend different tests to determine your diagnosis and verify the need for surgery. These tests include:

• Ultrasound doppler studies to check the flow of blood through the carotid arteries
• MRI or CT scan
• Arteriography (injection of dye to get images of the inside of the carotid artery)

If your healthcare provider recommends a carotid endarterectomy, prior to surgery tell him or her about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before surgery. These may include:

• Medications you should not take before the surgery, such as blood thinners
• Regular medications you should take on the day of your surgery
• How many hours you should stop eating and drinking before surgery

If you are a smoker, you should quit smoking, as it can interfere with your recovery

During your surgery, you will receive anesthesia to keep you comfortable and pain free.

• General anesthesia is the most common type of anesthesia for a carotid artery endarterectomy. With this type of anesthesia, you are put into a deep sleep and are unable to see, hear, or feel anything.
• In some cases, local anesthesia and a relaxing medication may be used for a carotid artery endarterectomy.

You will likely spend a day or two in the hospital after surgery. You may need pain medication and help at home while you recover.

Contact your healthcare provider if you are having symptoms of carotid artery disease. Be prepared to discuss your symptoms and how long you have had them. Remember, Time is critical when the blood flow to the brain has been decreased. Seek immediate medical attention if you experience symptoms of a stroke.

• Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations)
• Make a list of your medications (including over-the-counter)
• Write down any questions, symptoms or concerns you want to talk about.
• If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

Ask your healthcare provider the following questions.

• Am I at risk for a TIA or stroke? How can I decrease my risk?
• What are my treatment options?
• Can my symptoms be controlled with medications? If so, are their Tier 1 or Tier 2 medications on my Prescription Drug List that I should take?
• Do I need any special tests? What are the benefits and risks of having the tests?
• Will the tests change your treatment recommendations? If not, is there a need for them?
• What are the benefits and risks of this procedure? Are there less invasive treatment options for me?
• What type of anesthesia will you use?
• What is your success record with this type of procedure?
• Will I need to take a blood thinner after the procedure? For how long?
• What activity restrictions will I have? For how long? When can I return to work?
• What symptoms are normal after the procedure? When should I be concerned?
• How long after surgery should I follow-up with you?

Source UHC.com

Also known as:

Plaque

Endarterectomy

CEA

Carotid Artery Surgery - Endarterectomy

Carotid Artery Surgery