What is a carotid endarterectomy?
Carotid endarterectomy (CEA) is surgery to treat carotid artery disease. The carotid artery is the main blood vessel that carries oxygen and blood to the brain. In carotid artery disease, these arteries are narrowed. This reduces blood flow to the brain and can cause a stroke.
In brain damage Carotid endarterectomy, your health care provider will surgically remove plaques that build up inside the internal carotid artery. Houhe will perform an endarterectomy by making a cut (incision) in the side of the neck above the affected carotid artery. The artery is opened and the plaque removed. Your health care provider will sew the artery back together. This restores normal blood flow to the brain. You may have this procedure while you're awake under local anesthesia or while you're sleeping under general anesthesia
Why might I need a carotid endarterectomy?
Carotid endarterectomy is a procedure that occurs due to narrowing of the carotid artery due to atherosclerosis. This is the buildup of plaque in the inner lining of the artery. Plaque is made up of lipids, cholesterol, cellular waste products, calcium and fibrin. Atherosclerosis is also called “atherosclerosis.” It can affect arteries throughout the body. Carotid artery disease is similar to coronary artery disease. in a coronary artery diseaseBlockages form in the arteries of the heart and may cause a heart attack. In the brain, it can lead to a stroke.
The brain needs a constant supply of oxygen and nutrients to function properly.
Even a short interruption in the blood supply can cause health problems. Brain cells begin to die after only a few minutes without blood or oxygen.
If the narrowing of the carotid artery becomes severe enough to block blood flow, or if a piece of plaque breaks off and obstructs blood flow to the brain, a stroke may occur, called a mini-stroke (transient ischemic attack, or TIA), since its symptoms are similar to a stroke. ischemic and lasts from a few minutes to a few hours. A TIA may be the first sign of the disease.
You may not have symptoms if you have carotid artery disease. Plaque buildup may not block enough blood flow to cause symptoms. Partially blocked artery, 50% or less often causes no symptoms.
Your health care provider may have other reasons to advise you about having a carotid endarterectomy.
Basically what are the risks of carotid endarterectomy?
Some of the potential complications of carotid endarterectomy include:
- Stroke or TIA
- Heart attack
- Blood pools in the tissues around the incision site, causing swelling
- Nerve problems with certain functions of the eyes, nose, tongue, or ears
- Bleeding into the brain (intracerebral hemorrhage)
- seizures (uncommon)
- Recurrent carotid artery occlusion. Or a new blockage appears in an artery on the other side of your neck.
- Bleeding at the incision site in the neck
- high blood pressure
- Airway obstruction from swelling or bleeding in the neck
If you have an allergy to medications, contrast dye, iodine, or latex, tell your healthcare provider. Also tell your healthcare provider if you have or have ever had kidney failure or other kidney problems.
There may be other risks depending on your condition. Discuss any concerns with your healthcare provider before the procedure.
How can I prepare for a carotid endarterectomy?
- Your health care provider will explain the procedure to you and you can ask questions.
- You will be asked to sign a consent form giving permission to perform the procedure. Read the form carefully and ask questions if something is unclear.
- Your health care provider will review your health history and perform a physical examination to make sure you are in good health before undergoing the procedure. You may have blood tests or other diagnostic tests.
- Tell your healthcare provider if you are allergic to, or allergic to, any medications, iodine, latex, tape, contrast dye, or anesthetics.
- Tell your healthcare provider of all prescription drugs, medications, and herbal supplements you're taking.
- Tell your healthcare provider if you have a history of bleeding disorders. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be asked to stop some of these medications before the procedure.
- If you are pregnant or think you could be, tell your healthcare provider.
- Follow the instructions you were given not to eat or drink before the surgery.
- Your health care provider may order a blood test before the procedure to see how long it takes for your blood to clot.
- You may be given medication (a sedative) before the procedure to help you relax.
- Tell your healthcare provider if you have a pacemaker.
- If you smoke, stop smoking as soon as possible before the procedure. This may help you recover faster. It may also improve your general health. Smoking increases the risk of blood clots.
- Depending on your situation, your health care provider may give you other directions to prepare.
What happens during a carotid endarterectomy?
Carotid endarterectomy requires a hospital stay. Procedures may vary based on your condition and your healthcare provider's practices.
In general, a carotid endarterectomy (CEA) follows this process:
- You will be asked to remove any jewelry or other objects that may interfere with the procedure.
- You will take off your clothes and put on a hospital gown.
- You will be asked to empty your bladder before the procedure.
- An IV line will start in your arm or hand. Another catheter will be placed in your wrist to monitor your blood pressure and take blood samples. One or more additional catheters may be placed in your neck, opposite the surgical site, to monitor your heart. Other catheter sites include the subclavian and groin area.
- If there is a lot of hair at the surgery site, your health care team may shave it off.
- You will be placed on the operating table, lying on your back. Your head will rise slightly and move away from the side to be operated on.
- A catheter will be inserted into the bladder to drain urine.
- The anesthesiologist will check your heart rate, blood pressure, breathing, and blood oxygen level during surgery.
- CEA can be done under local anaesthesia. You will feel sleepy, but you will not feel the area being operated on. You'll be given an intravenous sedative before the procedure to help you relax. This allows the health care provider to monitor what you're doing during the procedure by asking you questions and testing your grip strength.
- If CEA is performed under local anesthesia, your health care provider will provide you with ongoing support and keep you comfortable during the procedure. You will be given pain medication as needed.
- Under local anesthesia, you'll be given oxygen through a tube inserted into your nose.
- CEA can also be performed under general anaesthesia. This means that you will be asleep. Once you're sedated, your provider will place a breathing tube in your throat and windpipe to supply air to your lungs. You will be connected to a ventilator. This machine will breathe during the surgery.
- You will be given a dose of antibiotics through a vein to help prevent infection.
- The health care team will clean the skin over the surgery site with an antiseptic solution.
- The health care provider makes a cut (incision) down the side of the neck over the affected artery. Once the artery is detected, the provider cuts the artery.
- Your health care provider may use a device called a shunt to divert blood flow around the area of surgery. This will maintain blood flow to the brain. A shunt is a small tube inserted into the carotid artery to send blood flow around the area being operated on.
- With a shunt, the health care provider removes the plaque from the artery.
- The provider will then remove the shunt and carefully close the artery. The incision in the neck is sewn together.
- A small tube (drain) may be placed in your neck. This will drain any blood into a small, palm-sized suction bulb. It is generally removed the morning after the operation.
- You can get blood pressure medication through your IV during and after the procedure to keep your blood pressure within a certain range.
- If you've had general anesthesia, your health care provider will wake you in the operating room to make sure you can answer questions.
- A sterile bandage or bandage is placed over the surgical site.
What happens after carotid endarterectomy?
in the hospital
After the operation, you will be taken to the recovery room. Once your blood pressure, pulse and breathing are stable and you are awake, you may be moved to an intensive care unit (ICU) or your hospital room.
In time, you will be helped out of bed to walk around as much as you can tolerate.
If a drainage tube was placed in the incision during the procedure, your health care provider will likely remove it the next morning.
Solid foods will be served to you as you can handle them.
Take a pain reliever as recommended by your health care provider. Aspirin or some other pain medications may increase the chance of bleeding. Make sure to take only recommended medications.
Your health care provider may schedule you for a follow-up duplex ultrasound to monitor the carotid artery in your neck. This will be done annually to make sure the plaque does not build up again.
In general, you can go home within one to two days after carotid endarterectomy.
Once you return home, it is important to keep the incision area clean and dry. Your health care provider will give you specific instructions for bathing. If stitches are used, they will be removed during a follow-up office visit. If using tapes, keep them dry and they will fall off in a few days.
You can return to your normal diet unless your health care provider tells you otherwise. A diet low in fat and cholesterol is generally recommended. You should eat vegetables, fruits, low-fat or fat-free dairy products, and lean meats. Avoid processed or packaged foods.
Driving is usually allowed once the painkillers are off and you can easily turn your head to check your surroundings on the road and blend in safely with traffic.
Tell your healthcare provider to report any of the following:
- fever or chills
- Redness, swelling, bleeding, or other drainage from the incision site
- Increased pain around the incision site
Your doctor will discuss the results of the procedure with you. For most people,
This procedure helps prevent further brain damage and reduces the risk of stroke. However, unless patients adopt a healthier lifestyle, plaque buildup, clot formation and other problems in the carotid artery can return.
How long does carotid artery surgery take?
A carotid endarterectomy usually takes one to two hours.
What percentage of carotid artery stenosis requires surgery?
With a blockage of more than 50 percent, surgery is the best option.