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Carotid Artery Surgery

By

Sarah Lewis, PharmD

What is carotid artery surgery?

Carotid artery surgery is surgery to restore blood flow to your brain. It is a treatment for carotid artery disease and helps prevent stroke. Carotid artery surgery involves removing plaque buildup from your carotid arteries. 

Carotid artery disease, also called carotid artery stenosis, is a narrowing of your carotid arteries. You have two carotid arteries, one on each side of your neck. They are major arteries that carry blood from your heart to your brain. 

Carotid artery disease is caused by atherosclerosis, commonly called hardening of the arteries. Atherosclerosis is a buildup of plaque. Plaque is a sticky, waxy deposit of fats, cholesterol, calcium, and fibrous material. Carotid artery disease puts you at risk for stroke.

Carotid artery surgery is major surgery with risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having carotid artery surgery. 

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Types of carotid artery surgery

The types of carotid artery surgery procedures include:

  • Carotid endarterectomy involves opening the carotid arteries in your neck and removing the inner lining that is damaged by plaque. A patch graft may be placed to help widen the artery and improve the blood flow.

  • Carotid artery angioplasty and stenting is an option for patients who have a high risk of complications. This procedure involves inserting a small tube, or catheter, through a blood vessel in the groin or elbow. Your doctor guides the catheter to your carotid arteries and opens or widens the artery and places a stent.  A stent is a cylinder-like tube made of thin mesh. It holds your artery open after angioplasty. Stents remain in place after your surgery.

Other procedures that may be performed

Your doctor may perform other procedures with carotid artery surgery. These procedures show how much plaque is in your carotid arteries:

  • Carotid angiography makes images (called an angiogram) of the carotid arteries. This is a minimally invasive test that requires the placement of a catheter into your arm to inject dye into the carotid arteries.

  • Carotid ultrasound is a noninvasive, painless screening test that examines the carotid arteries and evaluates blood flow through them.

Why is carotid artery surgery performed? 

Your doctor may recommend carotid artery surgery to treat carotid artery disease. Carotid artery disease is a buildup of plaque inside the carotid arteries. This narrows the carotid arteries and can eventually block them completely. This reduces blood flow to the brain and increases the risk of stroke. 

Your doctor may only recommend carotid artery surgery if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on carotid artery surgery.

Carotid artery surgery treats carotid artery disease with any of the following conditions: 

  • Carotid artery stenosis of 60% or greater. Carotid stenosis is a narrowing of the carotid arteries. Your doctor may decide that carotid artery surgery is a good treatment for you if your carotid arteries are narrowed by 60% or more. This is true even if you do not have symptoms and have not had a stroke or a TIA.

  • Prior stroke, which occurs when the flow of blood to the brain stops

  • Prior transient ischemic attack (TIA), a group of stroke-like symptoms that generally resolves within 24 hours. A TIA is a warning sign that you are at risk for a stroke.

Who performs carotid artery surgery?

The following specialists perform carotid artery surgery:

  • Neurosurgeons specialize in the medical and surgical care of diseases and conditions of the brain, its blood vessels, and the nervous system.

  • Vascular and interventional radiologists perform carotid angioplasty and stenting. These doctors specialize in the treatment of blood vessel and other conditions using catheter-based procedures and imaging techniques.

  • Vascular surgeons specialize in surgical treatment of diseases of the blood vessels.

How is carotid artery surgery performed?

Your carotid artery surgery will be performed in a hospital using one of the following approaches:

  • Catheter surgery is a form of minimally invasive surgery used for carotid angioplasty and stenting. It involves inserting a catheter through a vessel in a groin or elbow. X-ray imaging guides the catheter tip to the blocked area of the carotid artery. Your doctor performs the angioplasty using a balloon, laser or drill to open your artery. Your doctor can also place a stent using the catheter. A stent is a cylinder-like tube made of thin mesh. Stents remain in place to keep your artery open after angioplasty.

  • Open surgery is used for carotid endarterectomy. Your surgeon makes an incision or cut in your neck to expose the diseased part of your carotid artery. Your surgeon either clamps your carotid artery closed or places a temporary shunt around your artery. The next step involves cutting open the diseased part of your artery and removing the inner lining, including the plaque buildup. Your surgeon closes your artery—sometimes this requires a “vein patch”—and unclamps it or removes the shunt. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than catheter surgery because it requires cutting and displacement of muscle and other tissues. Despite this, open surgery may be a safer or more effective method for some patients.

Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, and general health. Learn about the different types of carotid artery surgery and ask why your doctor will use a particular type for you.
Types of anesthesia that may be used

Your doctor will perform carotid artery surgery using either general anesthesia or regional anesthesia, depending on the specific procedure. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable. For carotid artery surgery, your doctor will use local anesthesia to numb the incision area in your groin or elbow where he or she inserts the catheter. Your doctor may ask you questions during the procedure. This will help monitor your brain’s response to decreased blood supply if your carotid artery is clamped shut.

What to expect the day of your carotid artery surgery

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 you understand and sign the surgical consent form.

  • 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. 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 have.

  • A surgical team member will start an IV. 

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube is placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of carotid artery surgery?  

As with all surgeries, carotid artery surgery involves risks and possible complications. Complications may become serious and life thr