Carotid Endarterectomy

Your Care Explained > Tests and Procedures : Carotid Endarterectomy

Carotid endarterectomy is a surgical procedure to treat carotid artery disease in certain circumstances. It helps to prevent stroke by removing obstructions that impede blood flow to the brain.

Although women and men have similar benefits from endarterectomy, women have a higher risk of complications during and after surgery, so we are especially attentive to your recovery.

What to Expect:

  • No food or drink for 8 hours before surgery.
  • You’ll be given a local or a general anesthesia.
  • Blood flow will be diverted during surgery to maintain the brain’s blood supply.
  • You’ll have a small incision in your neck.
  • You’ll be in the hospital 2 to 3 days.
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Preparing for Carotid Endarterectomy

If you smoke, you should stop smoking as soon as possible prior to the procedure.

A few days before the procedure, you’ll have a pre-operative visit with your doctor. Your physician will perform a physical examination to determine your general state of health and will take a complete medical history. This is the time to let your doctor know all the medications you’re taking, the substances you’re allergic to, whether you have a pacemaker, if you are pregnant or think you might be, and whether you have a bleeding disorder. You may undergo blood tests or other diagnostic tests.

Your physician will explain the procedure to you and you’ll be able to ask any questions that you might have about the procedure. You’ll be asked to sign a consent form acknowledging that you understand the procedure’s benefits and risks, and giving your permission to do the procedure. Read the form carefully. Again, ask questions if something is not clear.

You will be asked to fast for eight hours before the procedure, generally after midnight.

During Carotid Endarterectomy

On the day of your endarterectomy, you will check into the hospital and be fitted with an identification bracelet.

You will be asked to remove your clothing and any jewelry or other objects that may interfere with the procedure. You will be given a gown to wear. You will be asked to empty your bladder.

An intravenous (IV) line will be started in your arm or hand. An additional catheter will be inserted in your wrist to monitor your blood pressure, as well as to obtain blood samples. One or more additional catheters may be inserted into your neck, opposite the surgery site, to monitor your heart function. Alternate sites may be the collarbone region and the groin.

You will be positioned on the operating table, lying on your back, with your head raised slightly and turned away from the side to be operated on. A catheter will be inserted into your bladder to drain urine.

If the endarterectomy is performed under local anesthesia, you will receive a sedative medication in your IV and oxygen through a nasal cannula, a tube that fits in your nose. You will remain awake, but sleepy, allowing the physician to monitor how you are doing during the procedure by asking you questions and testing your hand grip strength. The physician will keep you comfortable during the procedure. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing and blood oxygen level and administer pain medication during the surgery.

If the endarterectomy is performed under general anesthesia, a breathing tube will be inserted through your throat into your lungs once you are sedated. You will be connected to a ventilator, which will breathe for you during the procedure.

You will be given a dose of antibiotics through your IV to help prevent infection. You may receive blood pressure medication through your IV during and after the procedure to keep your blood pressure within a certain range.

The skin over the surgical site will be cleansed with an antiseptic solution. The surgeon will make an incision (cut) down the side of the neck over the diseased artery. Once the carotid artery is exposed, he or she will make an incision into the artery. The surgeon may use a device called a shunt—a small tube that is inserted into the carotid artery to deliver blood flow around the area being operated on. With the blood flow diverted, the physician will remove the atherosclerotic plaque from the artery.

Once the artery is clean, the shunt will be removed and the artery will be closed. The incision in the neck will be sutured together. A small tube may be inserted in the neck area to drain any accumulation of blood. It is generally removed the morning after the procedure. If you received general anesthesia, the physician will wake you up in the operating room to be sure you can respond to questions. A sterile bandage/dressing will be applied.

After Endarterectomy

After the procedure you will be taken to the recovery room for observation. Once your blood pressure, pulse and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) or your hospital room. At the appropriate time, you will be assisted out of bed to walk around as tolerated. If a drainage tube was placed in your incision during the procedure, it will be removed the next morning. Your physician may schedule you for follow-up duplex ultrasound procedures to monitor the carotid arteries in your neck for a period of time.

Generally, patients are able to go home after one or two nights in the hospital following a carotid endarterectomy. Once you are home, it is important to keep the incision area clean and dry. Your physician will give you specific bathing instructions. If stitches are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry, and generally will fall off within a few days.

You may resume your normal diet unless your physician advises you otherwise. Notify your physician if you have any signs of infection, such as fever and/or chills or redness, swelling, pain, bleeding or other discharge from the incision site. You may need to take a pain reliever for soreness; be sure to take only medications recommended by your physician.

Date Last Modified: January 21, 2011

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