Understanding Carotid Endarterectomy

What is carotid endarterectomy?

Endarterectomy is a common surgical procedure used to reopen arteries that have become partially or completely blocked, making it hard for blood to flow through them.

Although this procedure can be used to treat arteries throughout the body, it is most often used to reopen one or both of the major arteries in the neck, called carotid arteries. In these cases, the procedure is called a carotid endarterectomy.

Why are carotid endarterectomies performed?

The carotid arteries carry blood from your heart to your brain. Due to normal aging or unhealthy lifestyle choices, one or more of your carotid arteries can become clogged with plaque, a sticky substance made up of cholesterol, calcium and other materials.

Over time, as plaque continues to build up on your carotid artery walls, the vessels can become so congested that blood has a hard time passing through them. This is a condition called carotid stenosis.

Because carotid stenosis can severely reduce or even block blood flow to your brain, it significantly increases your risk of developing a stroke or transient ischemic attack (TIA).

Doctors often recommend carotid endarterectomy to treat carotid stenosis, because it can help prevent stroke or TIA from occurring.

During the procedure, a surgeon opens the affected carotid artery and removes the plaque that has built up inside — allowing blood to flow freely through the artery and up to the brain.

Carotid endarterectomy can be used to treat people who already have had a mild stroke or TIA, in order to prevent another one from occurring. It also can be used to treat people who have not yet had a stroke, but who are at high risk because their carotid stenosis is so severe.

Preparing for your carotid endarterectomy

First, your neurosurgeon will confirm whether you are healthy enough for surgery. He will perform a thorough medical examination, review your medical history and, if necessary based on your current health status, order additional tests.

If you are approved for surgery, you will need to complete a consent form giving your Lyerly physician permission to perform the procedure. Please read the form carefully, and make sure to let your doctor know if you have questions or concerns.

The following general guidelines apply to most people who are scheduled to have a carotid endarterectomy. Your doctor or another clinician from Lyerly Neurosurgery may give you additional instructions.

• If you are a smoker, you must not smoke for at least seven days prior to your surgery. This will help reduce your risk of complications. Please let your doctor know if you need help with smoking cessation.
• The night before your surgery, you should not eat or drink anything after midnight.
• The morning of your surgery, do not take any prescription or over-the-counter medications that can increase bleeding risk. These include blood thinners and nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen and naproxen). However, if you are taking Plavix or aspirin under your Lyerly neurosurgeon's direction, please continue taking your daily dose unless a member of our team tells you otherwise.
• If you use other daily prescription medications, you may be able to take them as usual the morning of your surgery — your doctor will let you know what is safe to use.
• Unless instructed otherwise, your carotid endarterectomy will take place at Baptist Medical Center Jacksonville. Please check in at the registration area located on the first floor of the J. Wayne and Delores Barr Weaver Tower. You will be given detailed instructions on what time to arrive and where to park.
• Bring your prescription or over-the-counter medications with you to the hospital, in their original containers.
• Don't forget to notify our team if you have a history of bleeding disorders, or if you are allergic (or have a sensitivity) to any medications, anesthesia, latex or adhesive tape.

What to expect during your carotid endarterectomy

On average, a carotid endarterectomy takes one to two hours to complete.

The procedure can be performed under general anesthesia (meaning you will be asleep) or under local anesthesia. If you and your doctor choose local anesthesia, you will be given medication to numb your neck area so you cannot feel pain. However, you will be awake during the procedure and will be able to communicate with your surgical team.

Your surgeon will make a small incision in your neck to expose the carotid artery. He will then clamp the artery to temporarily prevent blood from flowing through it (making it easier to find and remove the blockage).

Although your brain will continue to receive blood from your second carotid artery on the other side of your neck, your surgeon may insert a special tube called a shunt into the artery that's being operated on. The shunt helps reroute blood around the blockage, so it continues to flow to your brain.

Once the shunt is in place, your surgeon will make an incision in the section of the artery that's blocked. He will remove the inner lining of the artery, which allows him to peel away the plaque that is blocking blood flow.

As soon as the plaque has been removed, your surgeon will stitch the artery closed, remove the clamp and the shunt, and close the incision on your neck.

From there, you will be taken to a recovery area for observation.

What to expect after your surgery

The average length of stay in the hospital following carotid endarterectomy is one to two days.

Immediately after surgery, you will be monitored closely by your doctor and his health care team. First you'll be taken to a recovery area for short term observation, and then you will be transferred to an inpatient room for continued surveillance.

Before you are discharged from the hospital, members of your health care team will help guide you through your transition to home. They will make sure you understand what medications to take, and when you may resume bathing, driving and physical activity.

Your doctor or another member of the Lyerly Neurosurgery team will give you detailed instructions for taking care of yourself once you're home. However, the following general guidelines apply to most people:

• It is normal to have pain and discomfort around the incision on your neck for several days. During this time you should avoid heavy lifting and other strenuous activities. Your doctor will talk to you about pain medications that are safe to use.
• Make sure to keep your incision clean and dry.

While you are recovering at home, pay attention to any unusual symptoms. Call our office at 904.861.0316 if you experience any of the following:

• redness, swelling, bleeding or drainage from your incision
• pain that gets worse over time, or cannot be managed with pain medication
• fever
• shortness of breath

Are there any risks I should be aware of?

As with any surgical procedure, carotid endarterectomy is associated with rare but serious risks. These include:

• an infection at the site of your incision
• temporary nerve injury that can cause hoarseness, difficulty swallowing, or numbness in the face or tongue
• a repeat blockage in the artery that was treated (called restenosis)
• stroke, if any plaque broke free during the procedure and became lodged in a different blood vessel

If you have any questions or concerns about the safety of this procedure, please do not hesitate to discuss them with your doctor.

Additional stroke prevention

Although carotid endarterectomy can reduce your stroke risk, it is important that you start or continue making healthy lifestyle choices to prevent carotid stenosis from returning.

Important lifestyle changes include quitting smoking, getting regular exercise, managing your blood pressure and eating foods low in fat, cholesterol and salt.

Carotid stenosis and stroke care at Lyerly Neurosurgery

Since Lyerly Neurosurgery was founded in 1934, our physicians have cared for thousands of people who need treatment for a brain or spine condition, including those who are at increased risk of stroke due to underlying conditions such as carotid stenosis.

Today our practice continues to build upon a legacy that blends compassion, safety and innovation. Our neurosurgeons provide the full spectrum of evidence-based care, including the latest minimally invasive procedures that can only be offered by neurosurgeons with advanced training and experience.

Together with Baptist Medical Center Jacksonville, our team performs emergency and preventive neurosurgery services including carotid endarterectomy, carotid angioplasty and stenting and endovascular stroke treatments.