Carotid endarterectomy remains the gold standard for treatment of carotid disease. It is an operation that has been performed for over 70 years and has a proven track record of long-term success in reducing the risk of stroke in appropriately selected patients.
This surgery typically takes one to two hrs and is performed under a light general anesthetic. The artery is identified through a small (5-7cm) incision along the side of the neck. It does not sit deep to the skin surface; the muscle is shifted to the side to expose it. The artery is then clamped temporarily and opened longitudinally. Sometimes a temporary silastic tube (shunt) is used to divert blood flow to the brain around the part of the artery we are working on. The plaque is removed by scraping the inner lining of the artery with a small spatula. The artery is reclosed by sewing a small Dacron patch into the open edges of the artery, so that the artery is larger than it was before. The patch decreases the chance of recurrent narrowing to less than five percent in your lifetime.
Patients typically stay overnight in the hospital and are discharged the following morning. Sometimes, blood pressure medications are held or adjusted temporarily after surgery because it is not atypical for the blood pressure to be transiently lower than usual after carotid surgery. It is common to have a sore throat or hoarseness for a few days after surgery, because of the breathing tube. We ask you to keep your head elevated at nighttime on two to three pillows and not to drive nor do heavy lifting or swimming for the initial two weeks after surgery, but otherwise, there are not activity restrictions. It is common to have numbness around the incision after surgery; the area involved will decrease over time.
Risks of this procedure include heart and lung issues, nerve injury (less than one percent), stroke or mini-stroke (one to three percent nationally). Bleeding issues and infection are rare (less than five percent).