About 795,000 Americans experience a stroke each year, and many of these strokes are caused by the buildup of plaque in the arteries, which can block the flow of blood to the brain. To clear that plaque and reduce the risk of stroke, doctors may recommend a carotid endarterectomy. This procedure is the third most common surgery for carotid artery disease, and it can slash stroke risk by half in people without prior stroke symptoms. Without complications, most people can resume work and normal activities within a few weeks after having a carotid endarterectomy.
What Is a Carotid Endarterectomy?
The carotid arteries are the large arteries in the front of the neck that supply the brain with oxygen-rich blood. But when plaque builds up in the carotid arteries, this waxy, fatty substance creates conditions that can lead to a stroke. Plaque buildup narrows the arteries and restricts the flow of blood to the brain, and bits of plaque can break off and travel to smaller arteries, where they block the blood flow. Carotid artery disease is typically diagnosed by carotid ultrasound, a painless and quick test that measures blood flow through the arteries.
A carotid endarterectomy is often recommended for people who have a moderate to severe blockage (70 percent or higher) of the carotid artery along with symptoms of a stroke or a transient ischemic attack, also known as a “mini-stroke.” People who have severe blockage of the carotid artery (80 percent or more) may also be candidates for a carotid endarterectomy, even if they don’t have symptoms of a blockage.
A carotid endarterectomy takes about an hour, typically under general anesthesia. Your surgeon makes an incision in the front of the neck to expose the diseased carotid artery and peels away the plaque from the artery wall. In some situations, the artery is patched with an artificial material or a piece of artery from another part of the body. The incision is then stitched or sealed.
Carotid Endarterectomy Post-Op Care in the Hospital
Without complicating factors such as age and other health conditions, you can expect to stay in the hospital for one to two days following surgery. During your hospital stay, you can expect to receive medications for pain and inflammation. Hospital staff will also encourage you to walk as soon as possible to encourage circulation and reduce the risk of pneumonia. If all goes well, you’ll be sent home with a set of carotid endarterectomy post-op care instructions and prescriptions for pain medications to take for the first few days of your recovery.
Carotid Endarterectomy Post-op Care at Home
A carotid endarterectomy involves an incision into the neck, so you can expect to have a sore throat and trouble swallowing for days or weeks after surgery. Although patients can typically resume a normal diet when they return home, you may want to favor soft, bland foods until the discomfort is gone. You may also experience numbness in the incision area, and this can linger for several months. Fatigue is also common after surgery, so it’s important to get plenty of rest.
For the first week or two after surgery, you may be advised to avoid driving, lifting anything that requires straining, and intense exercise such as running, cycling or weights. During this time, you can expect to see your doctors for follow-up care to remove stitches, check your incision, and monitor your condition for signs of stroke, nerve damage or infection. Your doctors may recommend a carotid ultrasound within a few months and then annually after that.
Most people are able to return to work and resume most normal activities between two and four weeks after surgery. But recovery can take longer for older patients or those who have ongoing health conditions such as hypertension, diabetes or cardiovascular disease.
Risks and Benefits of Carotid Endarterectomy
A carotid endarterectomy can significantly lower the risk of having a stroke in people who have moderate to severe blockage in the artery but who have had no symptoms of a stroke. For those who have already experienced a stroke or TIA, a carotid endarterectomy can lower the risk of a second event. But because carotid endarterectomy surgery is an invasive procedure, it carries risks.
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Along with the risks that accompany any surgical procedure, carotid endarterectomy carries a small risk of stroke for patients who had no stroke symptoms before surgery. That risk increases slightly for those who had experienced a stroke, “mini stroke” or TIA before the procedure. After surgery, your care team will monitor you carefully for signs of stroke, such as weakness, numbness in limbs, confusion or problems with coordination.
Heart Attack
In some patients, the stress of surgery can cause a heart attack during a carotid endarterectomy, and the risk rises for older patients and those with heart and problems or who have chronic conditions such as diabetes. Your surgery team will monitor your heart carefully throughout the procedure and intervene if necessary to prevent problems.
Nerve Damage
The area surrounding the carotid artery is rich with nerves that govern functions such as speech, swallowing and the movement of the head. During an endarterectomy, those nerves can be damaged, causing either temporary or permanent damage to the voice, tongue or back.
Lifestyle Changes Reduce Risks
A number of modifiable lifestyle factors can contribute to the development of plaque, so to reduce the risk of continued carotid artery disease, your doctors may recommend that you make some changes in your diet and lifestyle.
Control Blood Pressure
High blood pressure, or hypertension, plays a major role in heart disease and atherosclerosis, or hardening of the arteries. Controlling blood pressure through diet and exercise, or with medication, can help prevent a return of plaque.
Lower Cholesterol
Cholesterol is a major ingredient in artery plaque. Keeping cholesterol levels low with diet or medications can reduce the risk of new plaque buildup in a cleared artery or the development of plaque in other blood vessels.
Exercise
Lack of exercise and a sedentary lifestyle can contribute to the stiffening of artery walls, circulation problems and cardiovascular disease. Regular, moderate exercise, as your health permits, can help prevent the buildup of plaque.
Eat a Healthy Diet
An unhealthy diet can contribute to the buildup of plaque. A healthy diet low in sodium, saturated fats and sugars — and high in vegetables, fruits and healthy fats — can help keep weight and blood pressure down and cholesterol low.
Lose Excess Weight
Obesity plays a major role in cardiovascular disease as well as other health conditions, so maintaining a healthy weight for your age and body type can help reduce the risk of plaque buildup, heart attack and stroke.
Quitting Smoking
Smoking hardens and narrows arteries and contributes to many other health problems, so stopping is an important step toward keeping your heart and arteries healthy.
Carotid endarterectomy surgery is a generally safe procedure that can significantly reduce the risk of stroke for people who have plaque buildup in the carotid arteries, and without complications, recovery time can be short. Your surgeon and health care team will work with you to create the carotid endarterectomy post-op care plan that’s right for your life.
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