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Alternative Names Return to topCarotid endarterectomy; CEA; Carotid angioplasty and stenting; CAS; Endarterectomy - carotid artery; Angioplasty - carotid artery; Percutaneous transluminal angioplasty - carotid artery; PTA - carotid artery; Angioplasty - carotid artery
Definition Return to top
Carotid artery surgery is a procedure to restore proper blood flow to the brain.
Description Return to top
You have an artery on each side of your neck called the carotid artery. This artery brings needed blood to your brain and face.
The blood flow in this artery can become partly or totally blocked by fatty material called plaque. A partial blockage is called carotid artery stenosis (narrowing). Blockage in your carotid artery can reduce the blood supply to your brain. A stroke can occur if your brain does not get enough blood.
There are 2 ways to treat a carotid artery that has plaque buildup in it. One is surgery called endarterectomy. The other is a procedure called angioplasty with stent placement.
During carotid endarterectomy:
Carotid angioplasty and stenting (CAS) is a less-invasive way to repair the blockage in your carotid artery:
Why the Procedure is Performed Return to top
There are several ways your doctor may know you have narrowing or blockage in your carotid artery. Two common ones are:
Your doctor will need to do one or more tests to see how blocked one or both of your carotid arteries are.
If you have had a stroke, your doctor will consider whether treating your blocked artery is safe for you. Your doctor will compare your risk of having another stroke if you do not have surgery with the risk of having serious problems from the surgery itself. Your doctor must consider:
Treatment options your doctor will discuss with you are:
Most times, patients who have carotid angioplasty and stenting to treat severe narrowing of their carotid artery have this procedure because carotid endarterectomy would not be safe for them.
Risks Return to top
The risks for any anesthesia are:
The risks for any surgery are:
Risks of carotid surgery are:
Before the Procedure Return to top
Your doctor will do a thorough physical exam and several medical tests.
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
Do NOT drink anything after midnight the night before your surgery, including water.
On the day of your surgery:
After the Procedure Return to top
You may have a drain in your neck that goes into your incision. It will drain fluid that builds up in the area. It will be removed within a day.
After surgery, your doctor may want you to stay in the hospital overnight so that nurses can watch you for any signs of bleeding, stroke, or poor blood flow to your brain. You may be able to go home the same day if your operation is done early in the day and you are doing well.
Outlook (Prognosis) Return to top
Carotid artery surgery may help lower your chance of having a stroke. But you will need to make lifestyle changes to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. You may need to change your diet and start an exercise program, if your doctor tells you exercise is safe for you.
References Return to top
Chaturvedi S, Bruno A, Feasby T, Holloway R, Benavente O, Cohen SN, et al. Carotid endarterectomy -- an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2005;65:794–801.
Goldstein LB. Prevention and management of stroke. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders;2007:chap 58.
Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, et al. Endarterectomy versus stenting in patients with symptomatic severe carotidstenosis. N Engl J Med. 2006 Oct 19;355(16):1660-71.
Eckstein HH, Ringleb P, Allenberg JR, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective,randomised trial. Lancet Neurol. 2008 Oct;7(10):893-902. Epub 2008 Sep 5.Update Date: 2/9/2009 Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA.. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.