The carotid arteries carry blood to the brain. Plaque or fatty material that collect inside these arteries can affect blood flow. This can lead to stroke. Below are two procedures that can be used to widen the artery.
Carotid Endarterectomy is the removal of plaque from the carotid artery. This is done by making an incision in the neck. This surgery has a low risk of stroke or complication and typically results in a quick recovery with little pain. In most cases, patients are under general anesthesia during surgery, while others are awake with local anesthesia to control the pain.
During Surgery: An incision is made in the skin over the carotid artery. The surgeon places clamps on the artery above and below the blockage. This temporarily stops blood flow. The surgeon then makes an incision in the artery itself. A shunt may be used to preserve blood flow to the brain during the procedure. After the shunt is in place, the clamps are removed from the internal carotid artery. (In some cases a shunt is not needed because the brain is receiving enough blood through other arteries.) The surgeon loosens plaque from the artery wall. The plaque is then removed, often in a single piece. The surgeon inspects the artery to confirm that all of the plaque has been removed. He or she then closes the incision using either sutures or a patch. The surgeon may suture (stitch) the incision closed. The clamps are then removed. Next, the skin incision is closed. A tube (drain) may be put in place to keep fluids from collecting around the area.
Carotid Artery Stenting
Stenting is another treatment option for removing plaque from the carotid artery. Stenting is the placement of a wire mesh tube (stent) in the artery to hold it open. During the procedure, a long thin tube called a catheter is used to place the stent in the artery. This procedure is performed using local anesthetic. Your doctor will need to talk to you during the procedure, so you will be awake the entire time.
After the procedure you will most likely stay 1 to 2 days in the hospital.
Getting Ready For Surgery:
- Don’t eat or drink after midnight on the night before the procedure. (Ask your doctor whether you should continue to take any medications during this period).
- At the hospital, you will change into a hospital gown. An IV (intravenous) line will be started to provide you with fluids and medications.
During your hospital stay: you will receive medications to control pain if you need them. You will also be monitored and you may have certain tests. If you have a drain in place, it will be removed before you leave the hospital. An adult should drive you home.
Recovering at Home: Take it easy, but get back to your normal routine as much as possible. You can expect to be back to your usual activities in about a week. Meanwhile:
- Take medications as prescribed
- Keep the neck incision site clean and dry
- Avoid lifting anything over 10 pounds for about a week
- Do not drive until your doctor clears you to do so
- If you had an endarterectomy, shave carefully around the incision. You may want to use an electric razor
If you have stroke symptoms, call 911
Call your doctor if:
- You have problems at the incision or puncture site, such as swelling, redness, warmth, or increasing pain
- You experience mental confusion or headaches
Follow-Up: After the procedure, you will have a follow-up exam and tests. Ultrasound or other imaging tests may be needed regularly from now on. Restenosis (re-narrowing of the artery) is uncommon after either treatment, but it does sometimes occur. If so, you may need to have another procedure.