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If your doctor has recommended that you have a carotid endarterectomy, you are not alone. About 140,000 people undergo the procedure each year to help restore blood flow to the brain. Carotid endarterectomies were first performed in the mid 1950s, and by the 1960s and 1970s were used increasingly to help prevent stroke. Studies have shown that patients who have had a stroke or experienced the warning signs of one and have severe stenosis, or narrowing, of the carotid artery can reduce their two-year risk of stroke by more than 80 percent after undergoing the procedure.
A carotid endarterectomy involves making a small incision in the neck to expose the carotid artery. Blood that normally flows through the artery may be either re-routed through a shunt or the artery may be clamped above and below the blockage to prevent bleeding. Once the carotid artery is opened, the plaque that is clogging the inside of the artery is removed. The artery is then sutured shut, sometimes with part of a vein from the leg to widen or repair the vessel. The procedure may be performed under local, general or regional anesthesia, and takes approximately two hours. Recovery usually involves an overnight stay in the hospital to watch for possible complications, such as bleeding, low blood pressure or stroke. Upon returning home, patients are advised not to drive and to limit physical activity for several weeks.
A carotid endarterectomy can be performed not only to prevent a stroke, but also to treat symptoms of a blocked carotid artery, such as:
Any of these symptoms could be the sign of a serious health problem that requires immediate medical attention. However, some patients may have a blocked carotid artery without exhibiting any symptoms. Patients whose arteries are 70 to 99 percent blocked can decrease their two-year risk of having a stroke from one in four to one in 10 after undergoing a carotid endarterectomy. Patients with 50 to 69 percent blockage may be able to reduce their five-year risk of stroke by more than six percent after the procedure. Patients with 50 percent or less blockage may not experience enough benefit from the procedure to outweigh the risks of surgery.
A carotid endarterectomy can reduce the risk for stroke, but it does not completely stop plaque from building up again.
Lifestyle changes that may help minimize the chance of the arteries narrowing again include: