Carotid Endarterectomy - Symptoms, Risks, and Procedure

Creator: Dr. Shaqra Ekram
Published: 2022-12-05T18:29:39

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Carotid endarterectomy is a medical procedure to clear the fatty deposits within the carotid artery. This article is a brief overview of carotid endarterectomy.

Written by

Dr. Shaqra Ekram

Medically reviewed by

Dr. Prashant Valecha

December 5, 2022

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Contents

What Are the Signs and Symptoms of Carotid Artery Disease?
What Are the Risks Involved in Carotid Endarterectomy?
What Happens During Carotid Endarterectomy?
What Happens After Carotid Endarterectomy?

Introduction

Carotid artery stenosis also referred to as carotid artery disease, is the process of narrowing the arteries of the heart. The carotid arteries are two extremely robust blood vessels that always supply pure blood or oxygenated blood to the brain, which is responsible for critical thinking and speech, along with sensory and motor functions perform. At the side of the neck and the jaw, the pulse of the carotid artery can be felt.

Carotid artery disease has the strong potential to lead to the blockage of the cardiovascular blood vessels or the arteries of the heart. This will in turn, lead to a spike in the risk of heart stroke. The coronary arteries or the carotid arteries may undergo atherosclerosis- the long process of the stiffening and hardening of the inner surface of the arteries- leading to a drastic decrease in the flow of blood to the brain resulting in a life-threatening stroke.

Carotid endarterectomy is a quite invasive surgical approach for the treatment of carotid artery disease. In this procedure, the carotid artery is slit open, cleaned, and stitched back. The prognosis of carotid endarterectomy is good with a positive outlook, provided the patient follows the instructions of the healthcare professional and the nutritionist religiously.

What Are the Signs and Symptoms of Carotid Artery Disease?

An individual suffering from carotid artery disease may not show any particular signs or manifestation of carotid artery disease, and this is because of the build-up of heavy plaque within the walls of the arteries that take palace after a long-term. This is why it is said that carotid artery disease does not have any particular signs of warning.

Mentioned below are some of the signs and symptoms of carotid artery disease.

Blurring vision.
Generalized weakness.
Tingling sensation all over the body.
Impaired or vision loss.
Dizziness.
Confusion.
Difficulty in speech.
Severe attacks of headache.
Dementia.
Difficulty in swallowing.
Numbness.
Weakness of the limbs.
Weakness of facial muscles.
Difficulty in understanding speech.
Loss of balance.
Drooping one side of the face.
The trouble with information in sentences.
Paralysis of one side of the body.
Bruit or whistling sound of the heart.
Garbled speech.
Palpitations.
Slight pain in the neck or face.
Tenderness in the ear, jaw, or forehead.
Losing muscle strength over time.

What Are the Risks Involved in Carotid Endarterectomy?

Risks are the norm for any invasive or non-invasive procedure related to the cardiovascular system.

Mentioned below are the risks involved in carotid endarterectomy.

Stroke.
Heart attack.
Infection.
High blood pressure.
Swelling.
Pooling of blood.
Seizures.
Nervous system malfunctioning, especially of the five sensory organs.
Blockage of the carotid artery.
Intracerebral hemorrhage.
Bleeding at the site of the incision.
Irregular heartbeat.
Blocked airway path.

What Happens During Carotid Endarterectomy?

Carotid endarterectomy is suggested in case the patient suffers from carotid artery disease. The healthcare provider is the best person to finalize and give a green signal for carotid endarterectomy. If the professional feels a patient is not the right fit for carotid endarterectomy, carotid artery stent surgery and carotid angioplasty are the two varying alternatives.

Mentioned below are the steps that occur during carotid endarterectomy.

The patient is requested to empty their bladder before the procedure.
An intravenous line is placed in the arm.
Several other catheters and monitors are placed to evaluate the blood pressure and other vital signs as well as drain any excretory fluids.
Local anesthesia is administered, and a sedative is given for the patient to stay relaxed and calm.
General anesthesia is also an option but this is dependent on the patient and professional’s discussion.
Antibiotics are administered beforehand in order to avoid any occurrence of infection.
The surgical site is sterilized with the help of an antiseptic solution or alcohol swab.
The site or surgery receives an incision that exposes the carotid artery that needs to be treated.
A shunt is placed in order to divert the flow of blood from the surgical site. This is necessary to maintain constant blood flow to the brain.
While the shunt performs its function, the carotid artery is slit, and the accumulated fat and other plaque deposits are cleaned.
The shunt is then removed, and the carotid artery that has been treated is carefully closed.
The incision at the surgery site receives the required number of stitches.
A suction bulb is placed at the surgical site for a few hours to drain any excess fluid or pooling of blood.
A sterile dressing is finally placed.

What Happens After Carotid Endarterectomy?

After the completion of the procedure, the patient is continually monitored for several days in the intensive care unit or the recovery room. The diet is given after consultation with the respective surgeon and nutritionist. Specific bathing instructions are provided to the patient. Packaged foods, foods high in saturated fats and sugar, cholesterol-rich foods, and oily foods must be avoided. A mix of fresh fruits as well as green leafy vegetables with multiple strains of pulses and grains are to be followed. The diet plan is handed over to the patient after discharge which must be followed strictly.

Conclusion

Carotid artery stenosis, also called carotid artery disease has the potential to be a life-threatening disorder if it is not diagnosed at the right time and is not treated promptly. It may additionally lead to a stroke that will eventually lead to sudden death or even permanent disability.

Due to these reasons, one must always be aware of all the signs and symptoms of stroke as well as the clinical manifestations and thus act accordingly. An immediate, exact, and accurate management plan for carotid artery disease may definitely prove to be lifesaving. Carotid endarterectomy, or CEA, is the go-to treatment for carotid artery disease.

Additionally, the result of surgical intervention and stent placement is excellent. Therefore, the patient can expect a positive outlook after carotid endarterectomy. The quality of the patient's life is good, provided they follow the diet plan suggested after the procedure and strictly follow other preventive measures.

Frequently Asked Questions

1. Is Carotid Endarterectomy a Big Surgical Procedure?

Carotid endarterectomy is a severe procedure that carries risks and probable problems. Carotid endarterectomy is a procedure that includes opening the carotid arteries in the neck and removing the plaque-damaged inner lining. A patch graft may be used to expand the artery and enhance blood flow.

2. Is the Carotid Endarterectomy a Risky Procedure?

A carotid endarterectomy carries risks, just like any other form of surgery.
There are two primary risks:
- Stroke - the risk of stroke is roughly 2%, though it may be higher in those who have had a stroke before the operation.
- Death - the chance of death is less than 1%, which can happen due to consequences such as a stroke or heart attack.

3. What Is the Primary Reason for a Carotid Endarterectomy?

Carotid endarterectomy is advised for individuals with ipsilateral stroke or transient ischemic attack (TIA) history with carotid artery stenosis of 50% or greater.
One or both of the carotid arteries become restricted due to fatty deposit buildup, known as carotid artery disease or carotid artery stenosis; it considerably increases the chances of having a stroke or transient ischemic attack.

4. How Long Does a Carotid Endarterectomy Recovery Take?

Most people can return to work three to four weeks after undergoing carotid endarterectomy. Afterward, the surgeon or general practitioner can provide more information on returning to work. Being physically active can aid recovery, but do just what is necessary. The surgeon can tell patients how much activity they can undertake.

5. Are You Conscious During the Carotid Endarterectomy?

If general anesthesia is given, patients will be asleep and pain-free during carotid endarterectomy. But in some hospitals, the procedure is done under local anesthesia where the area to be operated on is alone numbed by giving local anesthesia. In addition, patients are given medicine to help them relax.

6. Which Is More Safer, a Stent or a Carotid Endarterectomy?

Carotid stenting for symptomatic carotid stenosis carries a greater risk of periprocedural stroke or mortality. Most of this increased risk is related to a rise in mild, non-disabling strokes in adults over 70. Carotid stenting is as effective as endarterectomy in avoiding recurrent strokes after the periprocedural interval. Endarterectomy is still preferred when combining procedural safety and long-term efficacy in preventing recurrent stroke.

7. Is It Painful to Have a Carotid Endarterectomy?

Patients might feel some pain in their neck near where the cut was done. Painkillers are usually effective in controlling this. They may also feel numbness surrounding the area, which should go away within a few days. A few hours following surgery, most people can eat and drink. In most cases, patients can leave the hospital and go home again in less than 48 hours.

8. What Is the Most Common Delayed Problem of Carotid Endarterectomy?

The following are some potential side effects of carotid endarterectomy:
- Stroke.
- Heart attack.
- Swelling is caused by the accumulation of blood in the tissue surrounding the incision site.
- Problems with the nerves that control specific eyes, ears, nose, tongue, or mouth functions.
- Blood loss in the brain (intracerebral hemorrhage).
- Seizures (uncommon).

9. What Is the Length of the Incision for a Carotid Endarterectomy?

During the procedure, Surgeon makes a four-inch-long incision at the site of the blockage. A small tube may be used to temporarily divert blood flow around the obstruction or narrowing while isolating the location.

10. Who Should Consider Getting a Carotid Endarterectomy?

The doctor may determine a good candidate for carotid artery surgery if patients meet the following criteria:
- Even when they are not experiencing symptoms, carotid arteries are 60% or more obstructed.
- History of stroke.
- History of TIAs (transient ischemic attacks).
- Nonsurgical treatments such as medicines and lifestyle changes have not been effective.

11. What Is the Essential Examination After a Carotid Endarterectomy?

After a carotid endarterectomy, blood pressure should be closely watched, and individuals who have cerebral hyperperfusion syndrome should be treated immediately if their blood pressure is excessive. In addition, blood pressure should be checked for several days following surgery in individuals who are regarded to be at risk for hyperperfusion syndrome and for at least seven days in patients who have headaches or other new neurological symptoms.

12. What Percent of Carotid Stenosis Is Required for an Endarterectomy?

Surgery is the better decision for symptomatic patients with a carotid artery blockage of 70% to 99%. It can also be considered for patients with blockages between 50% and 69%, though. Doctors believe surgery is the most beneficial alternative for individuals with moderate to severe carotid artery disease.

13. Does Carotid Endarterectomy Prevent Strokes?

In individuals with symptomatic stenosis of 70% to 99%, carotid endarterectomy reduces the incidence of a stroke three times more effectively than medical treatment alone.

14. Is Elevated Blood Pressure Typical After a Carotid Endarterectomy?

Hypertension after carotid endarterectomy is common but poorly understood. Its presence has been linked to an elevated risk of neurologic complications. It may result in myocardial infarction and cerebral vascular issues. Recent studies suggest that its etiology has been linked to medically induced carotid baroreceptor impairment.

15. Is a Carotid Endarterectomy Necessary Immediately?

- An emergency carotid endarterectomy may be considered in certain patients with acute internal carotid artery blockage and severe neurological impairments.
- Carotid endarterectomy should be performed in a semi-urgent mode, within two weeks, for individuals who have had a mild stroke with limited brain infarction.

Sources

Dr. Prashant Valecha

Cardiology

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