The carotid arteries, which are located on either side of your neck, provide your face and brain with the oxygen-rich blood they need 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 — which is composed of compounds such as fat, cholesterol, and calcium — builds up in your carotid artery and narrows the artery. This narrowing is referred to as a stenosis and can restrict the flow of blood.
Pieces of this plaque may break loose and travel to a smaller artery in the brain. If this happens, it may cause an embolism. If the narrowing is significant enough, it can completely 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 disease 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 helps 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.
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Your doctor might recommend CEA if you meet certain criteria, such as when:
- you’ve already had a stroke
- you’ve already had a TIA
- the blockage of your carotid artery is severe but not complete
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 and measure the blood flow.
- Carotid angiography. This invasive X-ray procedure uses dye to highlight the artery, making the blockages 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 using dye as well.
The surgery will take place at a hospital and usually takes a few hours.
In this procedure, your surgeon will cut into the artery and remove the blockage. You’ll usually receive a general anesthetic, though it might be only local anesthesia that numbs the specific part of your neck.
The surgeon may decide to use a local anesthetic if they want to check your neurologic status during the procedure to see how your brain is responding.
The artery that’s 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.
Once the blockage is removed, the artery is stitched or patched 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’s built up.
You should talk with the surgeon about different patch materials. Your saphenous vein could be used as a patch. In this case, there would be a second incision on your leg. A surgeon may use a bovine pericardial patch, which comes from the lining of a cow’s heart. In some cases, a synthetic material is used, but it could increase short-term and long-term risk of infection.
Recovery time varies, and you’ll 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 of a stroke. Most patients go home within 24 hours.
There might be some soreness, numbness, swelling, and bruising in your neck, or it may be hard to swallow. Your doctor might put you on pain medication. Your surgeon will likely ask you to avoid heavy lifting and driving a car for 1 to 2 weeks.
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 a small risk of stroke, nerve damage, or even death. Other diseases like heart disease or diabetes can also complicate any surgical procedure.
It’s important to thoroughly discuss your options with your doctor before making the decision to have this procedure.
A carotid stent is another surgical alternative to a CEA. During this procedure, a slender metal tube called a stent is inserted into the artery, and the tube is inflated with a balloon to keep the artery open. The inflated balloon pushes the plaque deposit out of the way, reopening the pathway. The stent is designed to keep the pathway from becoming blocked in the future.
This procedure carries with it different risks, including a higher risk of stroke, and is generally reserved for specific situations.
Carotid artery surgery is a procedure for someone who has a narrowed carotid artery that can cause a stroke.
A doctor will perform surgery to unclog the artery. This surgery will typically include a stay in the hospital overnight to make sure everything went well.
Consult with your doctor if you’re having any of the signs and symptoms of a carotid artery blockage, and make sure that your surgeon is board certified in vascular surgery.