Persistently high cholesterol levels could eventually lead to atherosclerosis if not treated. Cholesterol binds to inflamed areas of the artery and builds up into a thick, waxy plaque within the wall of the artery. As the thickness of the plaque grows, it obstructs blood flow to various areas of the body.
The carotid arteries are responsible for transporting blood to the brain. Blood contains many nutrients and oxygen needed by the brain needed for it to carry out vital physiological processes. A carotid endarterectomy involves removing the plaque from the carotid artery and restoring blood flow to the brain.
Who Needs a Carotid Endarterectomy?
Your healthcare provider will determine whether or not you need a carotid endarterectomy based upon an assessment of your carotid arteries. To do this, your healthcare provider may perform an ultrasound, MRI or an angiography on your carotid arteries in order to determine the presence of plaques.You may be considered a candidate for a carotid endarterectomy if you have the following:
- If you have had a transient ischemic attacks (TIA) or stroke recently.
- If you are having symptoms of blockage (such as dizziness or difficulty remembering things).
- If you are found to have a plaque that causes at least 50% of stenosis of one or both of the carotid arteries.
How Do I Prepare For This Procedure?
Your surgeon will run a series of tests before your procedure. You should not eat or drink anything at least eight hours before your surgery. Let your surgeon know if you are taking any other medications –- including over-the-counter products –- before the procedure. He or she may want to discontinue these medications before you have the surgery.What Happens During a Carotid Endarterectomy?
The surgeon will place you under either local or general anesthesia during the procedure. The skin in the location of the affected area will be cleaned and shaved in order to prevent an infection at the site of the incision.An incision will be made on the affected side of the neck and the carotid artery will be carefully dissected from the surrounding tissue. The areas of the artery surrounding the plaque will be clamped in order to prevent blood flow in that area. Additionally, blood flow may be temporarily rerouted during the procedure if needed
The surgeon will carefully peel the plaque away from the inner wall of the artery. Once the plaque has been removed, the artery will be sutured shut, the clamps will be removed, and blood flow will be restored through the vessel. Another vessel or synthetic material may be required in some cases to close the carotid artery. The incision site at the carotid artery will be subsequently sutured.
This entire procedure will usually last a couple of hours.
What Should I Expect After the Procedure?
You will be kept in the hospital anywhere between one to five days, depending on your age, complications during the procedure, and other health conditions you may have that may place you at risk for having complications after the procedure. Complications are rare, but may include:- Bleeding at the site of incision
- Cranial nerve dysfunction (changes in voice, difficulty swallowing)
- Stroke
- Low blood pressure
- Myocardial infarction
- Infection at the site of infection
Recovery Period…
Your surgeon will let you know when it’s OK to resume your normal work and other daily activities. However, you may need to make some changes to your lifestyle in order to prevent plaque formation from recurring in your carotid arteries –- or other arteries -– in the body.Implementing a low fat diet and regular exercise into your life are two ways to lower your cholesterol and prevent plaque formation. Cholesterol-lowering medications, like statins, and other drugs, may also be prescribed for you. And if you were smoking before the procedure, now would be a good time to stop.
Be sure to keep all of your appointments and to let your healthcare provider know if you have any questions or are experiencing any problems after your discharge from the hospital.
Sources:
Fauci AS, ed. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.
The Merck Manual of Diagnosis of Therapy, 18th edition. 2006.
American Heart Association. 2008. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3009563. Accessed 15 November 2008.
Greenfield LJ, Mulholland MW, Oldham KT et al. Surgery: scientific principles and practice, 3rd edition. 2001.
