The carotid arteries, which are located on either side of your neck, provide your brain with the oxygen-rich blood it needs to function properly. Without this blood flow, your brain cells would die. When blood flow to an area of the brain is restricted or blocked, it may lead to a stroke. Strokes may cause temporary or permanent mental and physical impairment, and can be fatal.
If you have carotid artery disease, a substance called plaque builds up in your passages and restricts the flow of blood. If the deposits of plaque — which are composed of compounds such as fat and cholesterol — are significant enough, they can cut off blood flow to the brain and cause a stroke.
A surgery called carotid endarterectomy (CEA) is one way to remove blockages to the normal flow of blood and to minimize your risk of a stroke. A CEA is also known as carotid artery surgery.
Carotid artery blockages can cut off blood to the brain and can lead to a stroke. These blockages can be caused by plaque, or by a blood clot that has clogged the artery. By performing a CEA, your doctor is trying to keep blood flowing to your brain in order to prevent strokes.
Carotid artery surgery also helps prevent a transient ischemic attack (TIA). A TIA has the symptoms of a stroke — such as numbness, difficulties with speech or vision, and trouble walking — but they last for a brief time. According to the National Institute of Neurological Disorders and Stroke, symptoms of a TIA usually disappear within an hour. Like a stroke, a TIA is caused by a temporary blockage of blood to the brain.
Your doctor might recommend CEA if you meet certain criteria, including:
- you’ve already had a stroke
- you’ve already had a TIA
- the blockage of your carotid artery is severe
In the days before the surgery, your doctor may want to conduct tests that will give them a better picture of your arteries. Tests used to prepare for a CEA include:
- carotid ultrasound: sound waves are used to create a picture of the artery
- carotid angiography: an X-ray uses dye to highlight the artery, making the blockages more visible
- magnetic resonance angiography (MRA): magnetic and radio waves create a picture of the artery, sometimes with the use of contrast dye to get a clearer image
- computed tomography angiography: X-rays provide a 3D picture of the arteries, sometimes using dye as well
The surgery will take place at a hospital and usually takes a few hours. There are two versions of the CEA.
In the first type of procedure, your surgeon will cut into the artery and remove the blockage. You will receive anesthetic, though it might be only a local anesthetic that numbs the specific part of your neck. The surgeon may decide to use a local anesthetic if they want to speak with you during the procedure to see how your brain is responding.
The artery that is being cleared will be clamped during the surgery, but blood will still reach the brain through the carotid artery on the other side of your neck. A tube might also be used to reroute the blood flow around the artery receiving surgery.
In the second type of CEA, the section of the artery that has problems with plaque is turned inside out. The plaque is cleared away and then the artery is put back in its normal position. The technical term for this is eversion carotid endarterectomy.
Once the blockage is removed, the artery is stitched back together and unclamped and the opening in your neck is closed with stitches. You may need to have a drain in your neck to remove any fluid that has built up.
Recovery time varies and you may need to stay in the hospital overnight for monitoring. Your doctor will want to be sure that you don’t have any bleeding, poor blood flow to your brain, or other possible risk factors for a stroke. However, if your surgery was in the morning and you are doing okay, you may not need to stay the night.
There might be some soreness in your neck, or it may be hard to swallow. Your doctor might put you on pain medication and may also prescribe an anticlotting medication, like aspirin, for a while to minimize the risk of blood clots.
CEA is considered a reasonably safe procedure that can greatly reduce the risk of stroke if you have carotid artery disease. The procedure does carry some risk of stroke or even death. Other diseases like diabetes can also complicate the procedure.
It is important to thoroughly discuss your options with your doctor before making the decision to have this procedure.
A carotid angioplasty is another surgical alternative to a CEA. During this procedure, a slender tube is inserted into the artery, and a portion of the tube is inflated to remove the buildup in your artery.
The inflated balloon pushes the plaque deposit out of the way, reopening the pathway. The surgeon might also insert a small metal tube called a stent, which is designed to keep the pathway from becoming blocked in the future. You might also be put on a regimen of anticlotting medications to make it harder for your blood to clot. This also minimizes the chance of a stroke without surgery.