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The carotid arteries, which are located on either side of the neck just below the angle of the jaw, supply oxygen-rich blood to the front portion of the brain responsible for speech, sensory and motor function, personality, and thinking. In individuals with carotid artery disease, these arteries can become narrowed or blocked due to a buildup of plaque or other substances along the walls of the arteries, which poses a significant risk of stroke. A carotid endarterectomy is a surgical procedure commonly used to remove these blockages and restore blood flow to the brain.
Carotid artery disease does not always present with symptoms. The most common warning sign is a transient ischemic attack, sometimes referred to as a TIA or mini-stroke. These symptoms, which mimic a major stroke, can last anywhere from a few minutes to a few hours and include:
A transient ischemic attack is an emergency requiring immediate medical attention since the symptoms can progress to a full stroke at any time. Individuals experiencing a TIA have a 10 times greater risk of suffering a major stroke than someone who has not had a TIA.
A carotid endarterectomy is typically recommended for patients who have had a prior TIA or mild stroke to reduce the risk of future strokes. The procedure is also often recommended for patients with significant narrowing or approximately 80 percent blockage of the carotid arteries. Individuals with 60 to 80 percent blockage who are not experiencing symptoms may also be considered candidates for a carotid endarterectomy depending on their condition and risk factors.
A carotid endarterectomy is performed using general or regional anesthesia and takes approximately two hours. The surgeon makes an incision in the neck at the location of the blockage. The affected area is isolated, and blood flow is temporarily diverted around the site of the blockage. A lengthwise incision is made in the artery, which allows the surgeon to remove the plaque. The area is then closed with stitches and a patch of material designed to keep the area from re-narrowing. Blood flow is then restored back to the artery.
The carotid endarterectomy procedure is typically well tolerated, and most patients are allowed to go home the day after the surgery. It is normal to experience some neck pain and difficulty swallowing for the first few days following the surgery. The doctor may prescribe pain medication and recommend a diet of soft foods to ease the discomfort. Patients are also given specific instructions at the time of discharge regarding when they can return to work and other activities.
Patients undergoing a carotid endarterectomy are strongly advised to stop smoking, which can contribute to carotid artery disease and plaque formation. In many cases, patients are placed on low-dose aspirin therapy or anticoagulants, such as clopidogrel, to keep clots from developing or getting larger.