What to expect the day of your carotid endarterectomy

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent. It is important to verify the correct side of your neck with the operating staff.
  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. Your care team will give you blankets for modesty and warmth.
  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
  • A surgical team member will start an IV.
  • The anesthesiologist or nurse anesthetist will start your anesthesia.
  • A tube may be placed in your windpipe to protect and control your breathing. You will not feel or remember this or the surgery as they happen.
  • A team member will insert a catheter into your bladder to collect urine.
  • The surgical team monitors your vital signs and other critical body functions. This occurs throughout the surgery and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a carotid endarterectomy?

As with all surgeries, a carotid endarterectomy involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery

The general risks of surgical procedures include:

  • Anesthesia reaction, such as an allergic reaction and problems with breathing
  • Bleeding, which can lead to shock
  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of carotid endarterectomy

Complications of carotid endarterectomy can be serious and include:

  • Bleeding in the brain and brain damage
  • Death
  • Heart attack
  • Hyperperfusion syndrome. This can occur when your brain receives normal blood flow after it has had low blood flow to it. A severe headache that improves when you are upright is a classic symptom.
  • Low blood pressure, which is usually temporary
  • Nerve damage, which is usually temporary. This can make it difficult to swallow and cause numbness in your face.
  • Restenosis (narrowing) or plaque buildup in your carotid artery
  • Seizures (rarely)
  • Stroke
  • Throat swelling, which makes it difficult to breathe

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
  • Informing your doctor or radiologist if you are nursing or if there is any possibility that you may be pregnant
  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
  • Taking your medications exactly as directed
  • Telling all members of your care team if you have any allergies

How do I prepare for my carotid endarterectomy?

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for a carotid endarterectomy by:

  • Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, previous surgeries, medications, and allergies at all times.
  • Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
  • Losing weight before the surgery through a healthy diet and exercise plan
  • If you have high blood pressure, talk to your doctor about how to control it both before and after surgery. Good blood pressure control can help decrease your risk of complications with a carotid endarterectomy.
  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during deep anesthesia.
  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
  • Taking or stopping medications exactly as directed. For a carotid endarterectomy, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.