Carotid Stenosis and Carotid Endarterectomy

The carotid arteries are the large arteries in the neck that supply blood to the brain. Carotid stenosis is the narrowing of the carotid arteries. This narrowing can put you at risk for a stroke because it decreases blood flow to the brain (ischemic stroke or transient ischemic attack [TIA]). Carotid stenosis is also called carotid artery disease.

CAUSES

Carotid stenosis is usually caused by a buildup of plaque in the arteries. Plaque is also called atherosclerosis. Plaque can build up in any of your arteries. This commonly occurs as we grow older.

SYMPTOMS

Symptoms of decreased blood to your brain include:

  • Feeling faint.

  • Numbness or weakness in the arms or legs.

  • Difficulty with movements.

  • Difficulty speaking.

  • Vision problems.

If the arteries are left untreated, you are at risk of having a stroke or TIA.

TREATMENT

Nonsurgical Treatment

If appropriate, your caregiver will suggest medical options other than surgery. These include taking aspirin or other medicines that thin your blood (anticoagulants). Your caregiver can help you decide if these are acceptable treatment methods for you.

Surgical Treatment: Carotid Endarterectomy

A carotid endarterectomy is a surgical procedure to clear blockages in the carotid artery.

RISKS AND COMPLICATIONS

  • Bleeding.

  • Infection.

  • Stroke or TIA.

BEFORE THE PROCEDURE

  • Do not eat or drink for as long as directed by your caregiver before the procedure.

  • Your caregiver will advise you if there are any medicines that need to be withheld before the surgery, and for how long.

PROCEDURE

You will be given a drug to make you sleep (general anesthesia). After you receive the anesthetic, the surgeon will make a small cut (incision) in your neck to expose the artery. An incision is made in the artery and the plaque is removed. The artery is then repaired and the incision is closed in your neck with stitches (sutures).

AFTER THE PROCEDURE

You will stay in the hospital right after surgery. Recovery time varies, depending on your age, condition, general health, and other factors. You are usually able to return to a normal lifestyle within a few weeks.

HOME CARE INSTRUCTIONS

  • It is normal to be sore for a couple weeks after surgery. See your caregiver if this seems to be getting worse rather than better.

  • Take showers, not baths, for a few days after surgery or until instructed otherwise by your caregiver. Do not take a bath or swim until directed by your surgeon.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

  • An anticoagulant may be prescribed after surgery. This medicine should be taken exactly as directed.

  • Change bandages (dressings) as directed by your caregiver.

  • Resume your normal activities as directed by your caregiver.

  • Avoid lifting until you are instructed otherwise.

  • Make an appointment to see your caregiver for suture or staple removal when instructed.

  • Stop smoking if you smoke. This is a grave risk factor.

  • Stop taking the pill (oral contraceptives) unless your caregiver recommends otherwise.

  • Maintain good blood pressure control.

  • Exercise regularly or as instructed.

  • Lower blood lipids (cholesterol and triglycerides).

  • Eat a heart-healthy diet. Manage heart problems if they are contributing to your risk.

SEEK MEDICAL CARE IF:

  • There is increased bleeding from the wound.

  • You notice redness, swelling, or increasing pain in the wound.

  • You notice swelling in your neck or have difficulty breathing or talking.

  • You notice a bad smell or pus coming from the wound or dressing.

  • You have an oral temperature above 102° F (38.9° C).

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your initial symptoms are getting worse instead of better.

  • You develop any abnormal bruising or bleeding.

  • You develop a rash.

  • You have difficulty breathing.

  • You develop any reaction or side effects to medicine given.

  • You develop chest pain, shortness of breath, or pain or swelling in your legs.

  • You have a return of symptoms or problems that caused you to have this surgery.

  • You develop a temporary loss of vision.

  • You develop temporary numbness on one side.

  • You develop a temporary inability to speak (aphasia).

  • You develop temporary areas of weakness.

  • You have problems or concerns that have not been answered.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.