Carotid Endarterectomy for TIA and Stroke
Surgery Overview
Carotid endarterectomy is surgery to
remove
plaque
buildup in the
carotid arteries
. During a carotid
endarterectomy:
- A small incision is made in the neck just below
the level of the jaw. The narrowed carotid artery is exposed.
- The
blood flow through the narrowed area may be temporarily rerouted (shunted).
Rerouting is done by placing a tube in the vessel above and below the
narrowing. Blood flows around the narrowed area during the
surgery.
- The artery is opened and the plaque is carefully removed,
often in one piece.
- A vein from the leg may be sewn (grafted) on
the carotid artery to widen or repair the vessel.
- The shunt is
removed, and the artery and skin incisions are closed.
For more information about making the decision to have
surgery, see:
-
Stroke: Should I Have Carotid Endarterectomy?
What To Expect After Surgery
The surgery often takes about an hour.
Recuperation includes spending a short time in the recovery room and may
include about 24 hours in the intensive care unit to watch for
complications.
The hospital stay usually is 1 to 3 days. And
normal activities can be resumed within a week as long as the activities are
not physically demanding. There may be some aching in the neck for up to 2
weeks. It is important not to turn your head too often or too quickly during
your recovery.
Why It Is Done
Your doctor may suggest that you have this surgery if:
- You have had a mild
stroke
or one or more
transient ischemic attacks
(TIAs) in the past 6
months and you have 70% or more narrowing in your
carotid artery.
- You have a low risk of complications from the
surgery.
- You have 50% to 69% narrowing and have had at least one of
the following:
- One or more TIAs in the past 6 months.
- A series of small strokes in the past 6 months, and each small
stroke has left you a little more disabled.
- A mild or moderate
stroke in the past 6 months.
How Well It Works
You are most likely to benefit from surgery if you
have had symptoms and if your carotid artery is narrowed by 70% or more. People with less than 50% narrowing do not
seem to benefit from surgery.
1
Carotid endarterectomy is more effective
than treatment with medicine alone in preventing stroke for people who have
symptoms that can be attributed to a 70% to 99% blockage of the carotid
arteries.
2
Risks
The major risks associated with carotid
endarterectomy are:
- Stroke.
- Heart attack.
- Breathing problems.
- High blood pressure.
- Infection.
- Injury to nerves (usually causing vocal cord paralysis and problems
with managing saliva and tongue movement).
- Bleeding in the
brain.
- Plaque buildup, which may redevelop as a late complication
between 5 months and 13 years after surgery.
- Death.
What To Think About
Carefully weigh the benefits and
risks of surgery, and compare them with the benefits and risks of medicine
therapy. The success of medicine therapy will depend on how much narrowing
(stenosis) is present in the arteries and the choice of medicine. Risks of
surgery depend on your age, your overall health, the skill and experience of
the surgeon, and the experience of the medical center where the surgery is
done.
Tests such as carotid ultrasound, carotid arteriography, CT
angiography, or magnetic resonance angiography (MRA) are needed before surgery
to evaluate the amount of plaque buildup in the carotid arteries and the flow
of blood through the narrowed area. (For more information, see the Exams and
Tests section of the topic Stroke.) The blood vessels beyond the hardened area
are also evaluated. If those vessels are severely damaged, surgery may not be
helpful.
Carotid endarterectomy can be done several months
after a stroke or TIA. But people benefit most from the
surgery if it is done within 2 weeks of the stroke or TIA. Delaying surgery longer than 2
weeks increases the risk for stroke, because people are more likely to have a
stroke in the first few days and weeks after a first stroke or a TIA.
The likelihood of complications
from carotid endarterectomy varies, depending on the skill and experience of
the surgeon. The American Heart Association Stroke Council recommends that
surgery be done by a surgeon who has complications in less than 6% of the
endarterectomy surgeries that he or she performs and that the hospital rate of
complications be just as low.
2
- Before surgery, any medical condition that
increases the risk for stroke, such as
high blood pressure
or heart disease, needs to be
controlled.
- The benefits of surgery may be temporary if disease or causes are not also treated. Using long-term aspirin treatment,
getting regular exercise, lowering cholesterol levels, eating a low-fat diet,
and quitting smoking are important aspects of postsurgery treatment.
Complete the
surgery information form (PDF)
(What is a
PDF
document?)
to help you prepare for this surgery.
References
Citations
-
Biller J, et al. (1998). Guidelines for carotid
endarterectomy: A statement for healthcare professionals from a special writing
group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501–509.
-
Furie KL, et al. (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online October 21, 2010 (doi: 10.1161./STR.0b013e3181f7d043).
Credits
|
By
| Healthwise Staff |
|
Primary Medical Reviewer
| E. Gregory Thompson, MD - Internal Medicine |
|
Specialist Medical Reviewer
| Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation |
|
Last Revised
| January 7, 2011 |
Last Revised:
January 7, 2011
Biller J, et al. (1998). Guidelines for carotid
endarterectomy: A statement for healthcare professionals from a special writing
group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501–509.
Furie KL, et al. (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online October 21, 2010 (doi: 10.1161./STR.0b013e3181f7d043).
