Understanding Carotid Edarterectomy

Understanding Carotid Edarterectomy

What is carotid stenosis?

Carotid stenosis is the narrowing of the carotid arteries, which transport blood to the brain, due to a buildup of fatty material, or plaque, inside the artery. The fatty deposit is called plaque; the narrowing of the artery is called stenosis.

The degree of stenosis is usually expressed as a percentage of the normal diameter of the opening. If the artery narrows enough, it causes a decrease in blood flow to the brain. If the brain does not receive an adequate blood supply, symptoms such as slurring of speech, blurred vision, loss of coordination, or numbness or weakness in an arm or leg may result.

Many people with carotid stenosis do not have any symptoms at all. Symptoms may not occur unless an ulceration (shedding) develops in the plaque, encouraging the formation of blood clots, which can travel to the brain or obstruct the carotid artery.

What is a carotid endarterectomy?

A carotid endarterectomy is a surgical procedure in which the doctor removes fatty deposits from one of the two main arteries in the neck supplying blood to the brain. Removal of the blockage can prevent strokes. It is better to prevent a stroke than try to treat it after it has occurred. Carotid angioplasty may be considered. Consult your physician.

What tests will I have before surgery?

Before surgery, tests may include ultrasound, MRI/MRA, perfusion CT or arteriography. These tests provide information about the blood flow through the carotid artery. This information helps the surgeon plan your surgery.

MRI (Magnetic Resonance Imaging)

A noninvasive, advanced diagnostic tool that provides a high level of anatomical detail. It can be used to precisely locate a stroke in the brain and determine the amount and extent of damage. Due to its high level of sensitivity, MRI is particularly useful when the stroke involves small blood vessels.

Ultrasound imaging

A painless, noninvasive test in which sound waves above the range of human hearing are sent into the neck. Echoes bounce off the moving blood and tissue in the artery and can be formed into an image. In addition, ultrasound measures the velocity and turbulence of the blood flow in the artery.

MRA (Magnetic Resonance Angiography)

A noninvasive technology for imaging cerebral blood vessels. It is also sometimes used to study the carotid arteries for stenosis. MRA detects any blockage of the large blood vessels within the brain itself.

Perfusion CT (Computerized Tomography)

A noninvasive test that provides color images displaying blood flow changes in the brain. Color images are more reliable for quick location of the affected brain areas.

Standard arteriography

An invasive x-ray of an artery taken when a special dye is injected into another artery in the leg or arm. The doctor can see if there is obstruction or narrowing caused by plaque as the dye travels through the artery.

What should I ask my doctor?

How long does the surgery take?

Each surgery is different. Typically, this surgery is performed in less than two hours. Staff from the operating room will communicate your progress to your family.

How long will I stay in the hospital?

The first few hours after surgery are spent in the Intensive Care Unit. There, careful monitoring of your blood pressure, bleeding and speech can be provided. The entire hospital stay is usually just a few days.

What should I bring to the hospital?

Pack a small bag of overnight clothes and personal care items. Do not bring valuables. Bring a list of medications including vitamins and supplements (with exact names and dosages) that you take.

What lifestyle changes are required after surgery?

Once the clogged artery is opened, the goal is to keep it open. It is important to modify your lifestyle to limit the future development of plaque and have annual ultrasound screenings.

What type of anesthesia will I have?

Carotid endarterectomy may be performed under general or local anesthesia. You, your surgeon and your anesthesiologist should discuss the best method for you. During the procedure you will be closely monitored by the anesthesiologist and be kept comfortable and free of pain.

What can I do when I return home?

Be sure to make arrangements to have a friend or family member drive you home. Avoid heavy lifting and do only light activities for a few days. The doctor may review activities with you after the surgery.

Remember...

It is important to be your own best health advocate. A good way to do that is by committing to routine physical exams and diagnostic tests as often as is recommended by your vascular specialist. Early detection of circulatory problems is important for effective treatment.

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