Carotid endarterectomy may be performed under general or local anesthesia, and the procedure may take about 1-2 hours. If both the arteries are to be operated, the time doubles. Carotid endarterectomy is a procedure in which the plaque affected parts of the arteries supplying to the face and brain are opened up to improve blood flow. The plaque is usually made up of fat, cholesterol, and other substances from inside the carotid artery. Surgery to remove the buildup in your carotid artery may be done if the artery is narrowed by more than 70%.
Carotid endarterectomy can be performed using minimally invasive techniques or traditional open surgery.
- During a minimally invasive procedure, the surgeon will thread a balloon catheter through the femoral artery in the groin and guide it to the carotid artery in the neck. After the catheter is in place, the doctor may inflate the balloon to push open the cross-section of the carotid artery and improve blood flow. The doctor may also use a special device to prevent plaque material from moving further along the arteries and blocking blood vessels in the brain.
- In a traditional procedure, the patient may be positioned on the operating table and the patient may be lying on the back, with head raised slightly and turned away from the side. The doctor may make a cut down the side of your neck over the diseased artery, followed by another cut into the carotid artery. They will clamp the area of the artery containing the plaque to temporarily restrict the flow of blood. If needed, they may temporarily reroute the flow of blood from the area. After carefully opening the carotid, your surgeon will peel away the plaque from the artery wall. In some cases, they may insert a tiny tube (stent) to strengthen the artery and hold it open. After checking to ensure there is no residue left in the artery, they will close the opening using stitches or a patch. The incision in your neck will also be closed. A small drainage tube may be left in place to drain away any excess fluid.
- Once carotid endarterectomy is complete, the patient will be moved to the recovery ward and then admitted to the hospital. If a drainage tube was placed in the incision during your procedure, it is most likely to be removed the next morning, and the patient may be able to go home within 1-2 days.
- If both carotid arteries are blocked, the patient may need two procedures within a few weeks.
Most people make a good recovery from carotid endarterectomy. As with any surgical procedure, there could be complications including:
- Bleeding
- Infection
- Pain
- Voice change
- Difficulty swallowing
- Further narrowing of the carotid artery
- Stroke
- Death (rare)
What is the outlook (prognosis) of the carotid endarterectomy procedure?
References
Fairman RM, Jim J. Carotid endarterectomy. https://www.uptodate.com/contents/carotid-endarterectomy
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