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Carotid artery surgery

Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery

Carotid artery surgery is a procedure to restore proper blood flow to the brain.

The carotid artery brings needed blood to your brain and face. You have one of these arteries on each side of your neck. Blood flow in this artery can become partly or totally blocked by fatty material called plaque. This can reduce the blood supply to your brain and cause a stroke.

There are two procedures to treat a carotid artery that has plaque buildup in it. This article focuses on a surgery called endarterectomy. The other method is called angioplasty with stent placement.

Images

Carotid stenosis, X-ray of the left artery
Carotid stenosis, X-ray of the right artery
Blockage in internal carotid artery
Atherosclerosis of internal carotid artery
Arterial plaque build-up

Presentation

Carotid artery surgery

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Description

During carotid endarterectomy:

The surgery takes about 2 hours. After the procedure, your doctor may do a test to confirm that the artery has been opened.

Why the Procedure Is Performed

This procedure is done if your doctor has found narrowing or a blockage in your carotid artery. Your doctor will have done one or more tests to see how much the carotid artery is blocked.

Surgery to remove the buildup in your carotid artery may be done if the artery is narrowed by more than 70%.

If you have had a stroke or temporary brain injury, your doctor will consider whether treating your blocked artery with surgery is safe for you.

Other treatment options your doctor will discuss with you are:

Carotid angioplasty and stenting is likely to be used when carotid endarterectomy would not be safe.

Risks

Risks of anesthesia are:

Risks of carotid surgery are:

Before the Procedure

Your health care provider will do a thorough physical exam and order several medical tests.

Tell your provider what medicines you are taking, even medicines, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

Follow instructions on when to stop eating and drinking before surgery.

On the day of your surgery:

After the Procedure

You may have a drain in your neck that goes into your incision. It will drain fluid that builds up in the area. It will be removed within a day.

After surgery, your doctor may want you to stay in the hospital overnight so that nurses can watch you for any signs of bleeding, stroke, or poor blood flow to your brain. You may be able to go home the same day if your operation is done early in the day and you are doing well.

Follow instructions on how to take care of yourself at home.

Outlook (Prognosis)

Carotid artery surgery may help lower your chance of having a stroke. But you will need to make lifestyle changes to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. You may need to change your diet and start an exercise program, if your doctor tells you exercise is safe for you. It is also important to stop smoking.

Related Information

Hardening of the arteries
Stroke
Angioplasty and stent placement - carotid artery
EEG
Weakness
Muscle function loss
Recovering after stroke
Carotid artery disease
Transient ischemic attack
Dizziness
Confusion
Fainting
Decreased alertness
Cerebral angiography
Tips on how to quit smoking
Risks of tobacco
Stent
Surgical wound care - open
Aspirin and heart disease
Butter, margarine, and cooking oils
Cholesterol and lifestyle
Antiplatelet drugs - P2Y12 inhibitors
Controlling your high blood pressure
Dietary fats explained
Fast food tips
How to read food labels
Mediterranean diet
Stroke - discharge
Carotid artery surgery - discharge
Cholesterol - drug treatment
Angioplasty and stent placement - carotid artery - discharge

References

Arnold M, Perler BA. Carotid endarterectomy. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 91.

Biller J, Ruland S, Schneck MJ. Ischemic cerebrovascular disease. In Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 65.

Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. Catheter Cardiovasc Interv. 2013;81(1):E76-E123. PMID: 23281092 www.ncbi.nlm.nih.gov/pubmed/23281092.

Brott TG, Howard G, Roubin GS, et al. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021-1031. PMID: 26890472 www.ncbi.nlm.nih.gov/pubmed/26890472.

Perler BA. Carotid endarterectomy. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:937-941.

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Review Date: 6/10/2018  

Reviewed By: Deepak Sudheendra, MD, FSIR, RPVI, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania Perelman School of Medicine, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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