Definition of Carotid artery surgery:

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. Such a blockage can reduce the blood supply to your brain and may cause a stroke.

There are two invasive ways to treat a carotid artery that has plaque buildup in it. This article focuses on a surgery called endarterectomy.

For more information on the other procedure, see: Angioplasty with stent placement.

Description:

During carotid endarterectomy:

• You will probably receive general anesthesia. This will make you unconscious and unable to feel pain. Some hospitals may use local anesthesia instead. Only the part of your body being worked on will be made numb with medicine so that you will not feel pain. You will be given a medicine to help you relax.
• You will lie on your back on a padded operating table with your head turned to one side. The side that will face up is the side your blocked carotid artery is on.
• Your surgeon will make a surgical cut on your neck over your carotid artery. Your surgeon will put a catheter (a flexible tube) in place. Blood will flow through the catheter around the blocked area during surgery.
• Then your surgeon will open your carotid artery. The surgeon will remove the plaque inside your artery.
• Your artery will be closed up with stitches after the plaque is removed. Blood will now flow through the artery to your brain.
• Your heart and brain activity will be monitored closely during your surgery.

Why the Procedure Is Performed:

There are several ways your doctor may know you have narrowing or blockage in your carotid artery. Two common ones are:

• You may have had symptoms of a stroke or a transient ischemic attack (TIA, also called a mini-stroke). Some of these symptoms are weakness, blurred vision, confusion, or slurred speech.
• You may not have any symptoms, but your doctor may find a problem during a physical exam. Your doctor may hear something called a bruit when using a stethoscope to listen to your blood flow. A bruit is an abnormal sound in your artery.

Your doctor will need to do one or more tests to see how blocked one or both of your carotid arteries are.

Treatment options besides surgery that your doctor will discuss with you are:

• No treatment, other than checking your carotid artery with tests every year
• Medicine and diet to lower your cholesterol
• Tests to check your carotid artery and blood-thinning medicines to lower your risk of stroke. Some of these medicines are aspirin, clopidogrel (Plavix), and warfarin (Coumadin).

Surgery or angioplasty to remove the buildup in your carotid artery may be done if the carotid artery is narrowed by more than 70%, or if the narrowing is between 50% and 70% and your doctor feels that you have a very high risk of having a stroke.

If you have had a stroke, your doctor will consider whether treating your blocked artery with surgery is safe for you. Your doctor will compare your risk of having another stroke if you do not have surgery with the risk of having serious problems from the surgery itself.

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