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Carotid Endarterectomy

Surgery Overview

Carotid endarterectomy is surgery to remove plaque buildup in the carotid arteries. During a carotid endarterectomy:

  • A small incision is made in the neck just below the level of the jaw. The narrowed carotid artery is exposed.
  • The blood flow through the narrowed area may be temporarily rerouted (shunted). Rerouting is done by placing a tube in the vessel above and below the narrowing. Blood flows around the narrowed area during the surgery.
  • The artery is opened and the plaque is removed, often in one piece.
  • The shunt is removed, and the artery and skin incisions are closed.

What To Expect

The surgery takes about an hour. You may need to stay in the hospital for a day or two.

You can start to do most of your normal activities again within a week, but you may feel more tired than usual. For a few weeks, you'll need to avoid activities that make you work hard, like doing intense exercise or lifting anything heavy. You may have some aching in your neck for up to 2 weeks.

Why It Is Done

Carotid endarterectomy is done to help lower your risk of stroke.

Your doctor may recommend this procedure based on certain things. These include:footnote 1, footnote 2

  • The amount of narrowing (stenosis) in your carotid arteries. A procedure may be an option if the narrowing is 50% or more.
  • Whether you had a stroke or TIA within the past 6 months. If you have not had a stroke or TIA, it is less clear that the procedure will help you.
  • Whether you have a low risk (less than 6%) of stroke or death from a procedure.

Your doctor can help you understand your risk of stroke and whether endarterectomy might be an option for you.

How Well It Works

If you have not had a TIA or stroke

For people who have not had a stroke or TIA, it is not as clear when endarterectomy might be a good choice. The surgery may help prevent a stroke in the long run. But in the short run, it increases the risk of stroke and death. Medicine and lifestyle changes may work as well as surgery to prevent a stroke, and they don't have the risks of surgery.

Endarterectomy may be an option if you have more than 60% to 70% narrowing and you have a low risk of a serious problem from the surgery.footnote 3

It is not clear that this surgery will reduce your stroke risk more than medicines and lifestyle changes alone. Studies are being done to compare current medical therapy with endarterectomy.

If you have had a TIA or stroke

An endarterectomy can help lower your risk of stroke if your carotid artery is narrowed by 50% or more. People with less than 50% narrowing do not benefit from surgery.footnote 4

You may benefit most from endarterectomy if it is done within 2 weeks of the stroke or TIA. This is when the risk of another stroke is highest.

Risks

The risks of carotid endarterectomy include:

  • Infection.
  • Breathing problems.
  • High blood pressure.
  • Nerve damage that could cause serious problems, like trouble swallowing.
  • Bleeding in the brain.
  • Stroke, heart attack, or death.

The risks of a procedure depend on things like your age and your overall health. Who does the procedure and where it is done are also important.

What To Think About

The decision about whether to have a carotid artery procedure is different for every person. Your doctor can help you weigh the benefits and risks of these procedures and compare them with the benefits and risks of medical therapy.

Having a procedure does not take the place of medicines and a healthy lifestyle. If you decide to have the procedure, you will still need to take medicines and have healthy habits.

  • Carotid Artery Procedures After a Stroke or TIA

Related Information

References

Citations

  1. Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.
  2. Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.
  3. Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.
  4. Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.

Other Works Consulted

  • Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.
  • Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.

Credits

Current as ofJuly 22, 2018

Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine
Martin J. Gabica, MD - Family Medicine
Adam Husney, MD - Family Medicine
Robert A. Kloner, MD, PhD - Cardiology


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