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Carotid Endarterectomy


What is a carotid endarterectomy?

Carotid endarterectomy is an operation which involves removing the inner lining of your carotid artery. This eliminates a substance called plaque from your artery which restores blood flow.

As you age, plaque can build up in the artery walls. Plaque is made up of cholesterol, calcium, and fibrous tissue. As plague builds up, arteries narrow and stiffen. This is called atherosclerosis, or hardening of the arteries. When enough plaque builds up blood flow is reduced through your carotid arteries.

Your carotid arteries are located on each side of your neck.</p/>

Carotid artery disease is serious because clots can form on the plaque. Plaque or clots can break loose and travel to the brain. If a clot or plague blocks the blood flow to your brain, it can cause an ischemic stroke, which can cause permanent damage or death. When a clot or plaque blocks only a tiny artery in the brain, it may cause a transient ischemic attack (TIA), also known as a mini-stroke. A TIA is often a warning sign that a stroke may occur in the near future, and it should be a signal to get treatment soon, before a stroke occurs.

To remove plaque in your carotid arteries and help prevent a stroke, a carotid endarterectomy may be performed.

Preparation for the procedure:

Your vascular surgeon will give you the instructions you need to follow before the surgery, such as fasting.

Before your vascular surgeon performs a carotid endarterectomy, he/she may want to see how much plaque has built up in your arteries. A duplex ultrasound is usually done. Using painless sound waves a duplex ultrasound shows your blood vessels and measures how fast your blood flows. Other tests include computed tomography (CT) scan, computed tomographic angiogram (CTA), magnetic resonance angiography (MRA), or angiography.

During the procedure:

You may either be put to sleep or your anesthesiologist or surgeon can numb your neck area and keep you awake. Once you are either asleep or the area around your neck is completely numb the hair on your neck will be clipped. An incision is made on one side of your neck to expose your blocked carotid artery. The carotid artery is temporarily clamped to stop blood from flowing through. Your brain will receive blood from the carotid artery on the other side of your neck. Your surgeon can also insert a shunt to detour the blood around the artery that is being repaired.

After the artery is clamped, he/she makes an incision directly into the blocked section. The plaque deposit is removed. After removing the plaque, the artery is stitched and the clamp is removed. A patch is often used to widen the artery as part of the procedure. The patch material used can be your own vein, usually taken from the leg, or a synthetic material. The procedure takes about 2 hours but may seem slightly longer depending upon the anesthetic and preparation time.

After the procedure:

After the surgery, you may stay in the hospital for 1 to 2 days. Your progress will be monitored. You will receive fluid and nutrients through an IV. You may not feel significant pain because the neck incision is small.

After you go home, you should avoid driving and limit physical activities for several weeks.

If you notice any change in brain function, severe headaches or neck swelling, you should contact your physician immediately.

How to stay healthy:

Although a carotid endarterectomy can reduce your risk of stroke, it does not completely stop plaque from building up again. You should consider the following changes if you want to minimize the chance of hardening of the arteries:

  • Follow a diet that includes food low in saturated fat, cholesterol and calories
  • Exercise regularly
  • Maintain an ideal body weight
  • Talk to your doctor about cholesterol lowering medications
  • Quit smoking
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