Carotid Endarterectomy

Carotid endarterectomy (CEA) is
surgery to treat carotid artery disease. The carotid arteries are the main blood vessels
that carry oxygen and blood to the brain. In carotid artery disease, these arteries become
narrowed. This reduces blood flow to the brain and could cause a stroke.

During a carotid endarterectomy,
your healthcare provider will surgically remove plaque that builds up inside the carotid
artery. He or she will make a cut (incision) on the side of the neck over the affected
carotid artery. The artery is opened and the plaque removed. Your healthcare provider will
stitch the artery back together. This restores normal blood flow to the brain. You may have
this procedure while you are awake under local anesthesia or while you are asleep under
general anesthesia.

Narrowing of the carotid arteries
is most often caused by atherosclerosis. This is a buildup of plaque in the inner lining of
the artery. Plaque is made up of fatty substances, cholesterol, cellular waste products,
calcium, and fibrin. Atherosclerosis is also called “hardening of the arteries.” It can
affect arteries throughout the body. Carotid artery disease is similar to coronary artery
disease. In coronary artery disease, blockages form in the arteries of the heart and may
cause a heart attack. In the brain, it can lead to stroke.

The brain needs a constant supply
of oxygen and nutrients to work correctly. Even a brief break in blood supply can cause
problems. Brain cells start to die after just a few minutes without blood or oxygen. If the
narrowing of the carotid arteries becomes severe enough to block blood flow, or a piece of
plaque breaks off and blocks blood flow to the brain, a stroke may happen. A mini-stroke
(transient ischemic attack or TIA) is stroke like-symptoms that last only a few minutes to a
few hours. A TIA may be the first sign of the disease.

You may not have symptoms if you
have carotid artery disease. Plaque buildup may not be blocking enough blood flow to cause
symptoms. An artery that is blocked only halfway or less often does not cause any symptoms.

Your healthcare provider may have
other reasons to advise a carotid endarterectomy.

Some possible complications of carotid endarterectomy include:

  • Stroke or TIA
  • Heart attack
  • Pooling of blood into tissue around the incision site causing swelling
  • Nerve problems with certain functions
    of the eyes, nose, tongue, or ears
  • Bleeding into the brain (intracerebral hemorrhage)
  • Seizures (uncommon)
  • Repeated blockage of the carotid
    artery. Or new blockage that develops in the artery on the other side of your neck.
  • Bleeding at the incision site in the
    neck
  • Infection
  • High blood pressure
  • Irregular heart beat
  • Blocked airway from swelling or from
    bleeding in the neck

If you are allergic to or sensitive to medicines, contrast dye, iodine, or latex, tell
your healthcare provider. Also tell your healthcare provider if you have kidney failure
or other kidney problems.

There may be other risks based on
your condition. Discuss any concerns with your healthcare provider before the procedure.

  • Your healthcare provider will explain the procedure to you and you can ask
    questions.
  • You will be asked to sign a consent form that gives your permission to do the
    procedure. Read the form carefully and ask questions if something is not clear.
  • Your healthcare provider will review your health history and do a physical exam to
    make sure you are in otherwise good health before having the procedure. You may have
    blood tests or other diagnostic tests.
  • Tell your healthcare provider if you are sensitive to or are allergic to any
    medicines, iodine, latex, tape, contrast dye, or anesthesia.
  • Tell your healthcare provider of all
    prescription and over-the-counter medicines and herbal supplements that you are
    taking.
  • Tell your healthcare provider if you
    have a history of bleeding disorders. Also tell your provider if you are taking any
    blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood
    clotting. You may be told to stop some of these medicines before the procedure.
  • If you are pregnant or think you could be, tell your healthcare provider.
  • Follow any directions you are given
    for not eating or drinking before surgery.
  • Your healthcare provider may request a blood test before the procedure to find out
    how long it takes your blood to clot.
  • You may get medicine (sedative) before
    the procedure to help you relax.
  • Tell your healthcare provider if you have a pacemaker.
  • If you smoke, stop smoking as soon as
    possible before the procedure. This may help you recover faster. It may also improve your
    overall health status. Smoking raises the risk for blood clots..
  • Based on your condition, your
    healthcare provider may give you other directions for getting ready.

Carotid endarterectomy requires a stay in hospital. Procedures may vary based on your
condition and your healthcare provider’s practices.

Generally, carotid
endarterectomy (CEA) follows this process:

  1. You will be asked to remove any
    jewelry or other objects that may interfere with the procedure.
  2. You will
    remove your clothing and put on a hospital gown.
  3. You will be asked to empty
    your bladder before the procedure.
  4. An IV (intravenous) line will be
    started in your arm or hand. Another catheter will be put in your wrist to monitor your
    blood pressure and to take blood samples. One or more extra catheters may be put in into
    your neck, opposite the surgery site, to monitor your heart. Other sites for the catheter
    include the under the collarbone area and the groin.
  5. If there is too much hair at the
    surgical site, the healthcare team may shave it off.
  6. You will be placed on the operating
    table, lying on your back. Your head will be raised slightly and turned away from the side
    to be operated on.
  7. A catheter will be put in into your
    bladder to drain urine.
  8. The anesthesiologist will check your
    heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  9. CEA may be done under local anesthesia. You will be sleepy, but
    will not feel the area being operated on. You will get a sedative in your IV before the
    procedure to help you relax. This lets the healthcare provider monitor how you are doing
    during the procedure by asking you questions and testing your hand grip
    strength.
  10. If the CEA is done under local
    anesthesia, the healthcare provider will give you constant support and keep you
    comfortable during the procedure. You will get pain medicine as needed.
  11. Under local anesthesia, you will get oxygen through
    a tube that fits in your nose.
  12. A CEA may also be done under general
    anesthesia. This means you will be asleep. Once you are sedated, the provider will put a
    breathing tube into your throat and into your windpipe to provide air to your lungs. You
    will be connected to a ventilator. This machine will breathe for you during the
    surgery.
  13. You will be given a dose of antibiotics through your IV to help
    prevent infection.
  14. The healthcare team will clean the
    skin over the surgery site with an antiseptic solution.
  15. The healthcare provider will make a
    cut (incision) down the side of the neck over the diseased artery. Once the artery is
    exposed, the provider will make a cut into the artery.
  16. The healthcare provider may use a
    device called a shunt to divert blood flow around the surgery area. This will keep blood
    flowing to the brain. A shunt is a small tube that is put into the carotid artery to send
    blood flow around the area being operated on.
  17. With the blood flow diverted, the
    healthcare provider will remove the plaque from the artery.
  18. The provider will then remove the
    shunt and carefully close the artery. The incision in the neck will be stitched
    together.
  19. A small tube (drain) may be placed in
    your neck. This will drain any blood into a small palm-size suction bulb. It is generally
    removed the morning after the procedure.
  20. You may get blood
    pressure medicine through your IV during and after the procedure to keep your blood
    pressure within a certain range.
  21. If you had general anesthesia, the
    healthcare provider will wake you up in the operating room to be sure you can respond to
    questions.
  22. A sterile bandage or dressing will be
    put on the surgery site.

In the hospital

After the procedure you will be
taken to the recovery room. 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
helped out of bed to walk around as you can handle it.

If a drainage tube was placed in the
incision during the procedure, your healthcare provider will likely remove it the next
morning.

You will be offered solid foods as
you can handle them.

Take a pain reliever as recommended
by your healthcare provider. Aspirin or certain other pain medicines may increase the
chance of bleeding. Be sure to take only recommended medicines.

Your healthcare provider may
schedule you for follow-up duplex ultrasound procedures to monitor the carotid arteries in
your neck.

Generally, you can go home within 1
to 2 days after a carotid endarterectomy.

At home

Once you are home, it is important
to keep the incision area clean and dry. Your healthcare provider 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, keep them dry and they will fall off within a few
days.

You may go back to your normal diet
unless your healthcare provider tells you otherwise. It is generally advised to follow a
diet that is low in fat and cholesterol. You should eat vegetables, fruits, low-fat or
non-fat dairy products, and lean meats. Avoid foods that are processed or packaged.

Tell your healthcare provider to
report any of the following:

  • Fever or chills
  • Redness, swelling, or bleeding or other
    drainage from the incision site
  • Increased pain around the incision
    site

Call 911

Call 911 if any of the following occur:

  • Weakness, tingling, or loss of feeling
    on one side of your face or body
  • Sudden double vision or trouble seeing
    in one or both eyes
  • Sudden trouble talking or slurred
    speech
  • Sudden severe headache

F.A.S.T. is an easy way to remember the
signs of stroke. When you see the signs, you k now you need to call 911 fast. F.A.S.T. stands for:

  • F is for face drooping. One side of the face is drooping or numb. 
  • A is for arm weakness. One arm is weak or numb. When the person lifts
    both arms at the same time, one arm may drift downward.
  • S is for speech difficulty. You may notice slurred speech or trouble
    speaking. The person can’t repeat a simple sentence correctly when asked. 
  • T is for time to call 911. If someone shows any of these symptoms, even
    if they go away, call 911 right away. Make note of the time the symptoms first
    appeared. 

Your healthcare provider may give
you other instructions after the procedure, based on your situation.

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure