Christie Clinic - Medicine for Your Life

Our website is currently having technical difficulties. To view the site, please click here

Health Encyclopedia

Health Encyclopedia

An invaluable resource of health information.

Carotid artery surgery

Carotid artery surgery is a procedure to restore proper blood flow to the brain.

  • Alternative Names

    Carotid endarterectomy; CEA; Carotid angioplasty and stenting; CAS; Endarterectomy - carotid artery; Angioplasty - carotid artery; Percutaneous transluminal angioplasty - carotid artery; PTA - carotid artery; Angioplasty - carotid artery

  • Description

    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.

    • Sometimes the plaque may close off the artery enough to cause a stroke.
    • Other times a blood clot may form in the artery, block the narrow part, and stop blood from reaching the brain. This type of clot is called a thrombus. It stays in one place.
    • Other times, the clot can travel and get stuck in a smaller blood vessel in the brain. A clot that travels like this is called an embolism.

    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:

    • You will probably receive general anesthesia. This will make you unconscious and unable to feel pain. Some hospitals may use local anesthesia instead. With local anesthesia, only the part of your body being worked on will be made numb with medicine so that you will not feel pain.
    • You will lie on your back on a padded operating table with your head turned to one side. The side that will face up is the side your blocked carotid artery is on.
    • Your surgeon will make an incision (a cut) on your neck over your carotid artery. Your surgeon will put a catheter (a flexible tube) in place. Blood will flow through the catheter around the blocked area during surgery.
    • Then your surgeon will open your carotid artery. The surgeon will then remove the plaque inside your artery.
    • Your artery will be closed up with stitches after the plaque is removed. Blood will now flow through the artery to your brain.
    • Your heart and brain activity will be monitored closely during your surgery.

    Carotid angioplasty and stenting (CAS) is a less-invasive way to repair the blockage in your carotid artery:

    • Your surgeon will make an incision in your groin after using some numbing medicine. You will also be given medicine to relax you.
    • Your surgeon will insert a catheter (a flexible tube) through the incision into an artery. The doctor will carefully guide the catheter up to your neck to the blockage in your carotid artery.
    • Your surgeon will use live x-ray pictures to see your artery. This kind of x-ray is called fluoroscopy.
    • Next your surgeon will pass a guide wire through the catheter to the blockage. Another catheter with a very small balloon on the end will be pushed over the guide wire and into the blockage. Then the balloon will be blown up. The balloon then presses against the inside wall of your artery. This opens the artery and restores proper blood flow to your brain.
    • A stent (a wire mesh tube) may also be placed in the blocked area. The stent is inserted at the same time as the balloon catheter. It expands when the balloon is blown up. The stent is left in place to help keep the artery open. The surgeon then removes the balloon.
  • Why the Procedure Is Performed

    There are several ways your doctor may know you have narrowing or blockage in your carotid artery. Two common ones are:

    • You may have had symptoms of a stroke or a transient ischemic attack (TIA, also called a “mini-stroke”). Some of these symptoms are weakness, blurred vision, confusion, or slurred speech.
    • You may not have any symptoms, but your doctor may find a problem during a physical exam. Your doctor may hear something called a bruit when using a stethoscope to listen to your blood flow. A bruit is an abnormal sound in your artery.

    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:

    • How bad the narrowing in your carotid arteries is
    • What symptoms you have
    • What other medical problems you may have
    • Your age

    Treatment options your doctor will discuss with you are:

    • No treatment, other than checking your carotid artery with tests every year
    • Medicine and diet to lower your cholesterol
    • Tests to check your carotid artery and blood-thinning medicines to lower your risk of stroke. Some of these medicines are aspirin, clopidogrel (Plavix), and warfarin (Coumadin).
    • Surgery to remove the buildup in your carotid artery

    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

    The risks for any anesthesia are:

    The risks for any surgery are:

    Risks of carotid surgery are:

    • Blood clots or bleeding in the brain
    • Brain damage
    • Stroke (this is rare)
    • Heart attack
    • Seizures (this is rare)
    • Swelling near your airway (the tube you breathe through)
    • Allergic reaction to dye (only with carotid artery angioplasty)
    • More blockage of the carotid artery over time
  • Before the Procedure

    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:

    • You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
    • Ask your doctor which drugs you should still take on the day of your surgery.
    • If you smoke, you need to stop. Ask your doctor or nurse for help quitting.
    • Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

    Do NOT drink anything after midnight the night before your surgery, including water.

    On the day of your surgery:

    • Take your drugs your doctor told you to take with a small sip of water.
    • Your doctor or nurse will tell you when to arrive at the hospital.
  • After the Procedure

    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)

    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

    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.

Review Date: 2/9/2009

Reviewed 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.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2014 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Christie Clinic Christie Clinic at the Family Medical Center in Paris Photo Christie Clinic at the Family Medical Center in Paris
727 East Court Street Paris, IL 61944 Dermatology: 366-1248; Vein and Vascular: 366-2670
Christie Clinic Christie Clinic on University Photo Christie Clinic on University
101 West University Avenue Champaign, IL 61820 Main Phone: (217) 366-1200
Billing Services: (217) 366-1382
Toll Free: (888) 391-0412
Christie Clinic Christie Clinic on Windsor/Convenient Care Photo Christie Clinic on Windsor/Convenient Care
1801 West Windsor Road Champaign, IL 61822 (217) 366-8000
Christie Clinic Christie Clinic at Presence Covenant Photo Christie Clinic at Presence Covenant
1400 West Park Street Urbana, IL 61801 (217) 366-1200
Christie Clinic Christie Clinic in Rantoul Photo Christie Clinic in Rantoul
209 West Borman Drive Rantoul, IL 61866 (217) 892-9671
Christie Clinic Christie Clinic in Mahomet/Convenient Care Photo Christie Clinic in Mahomet/Convenient Care
1001 Commercial Drive Mahomet, IL 61853 Main Number: (217) 586-6600 Convenient Care: (217)366-8130
Christie Clinic Christie Clinic in Tuscola Photo Christie Clinic in Tuscola
300 North Main Street Tuscola, IL 61953 (217) 253-9258
Christie Clinic CU Sleep Photo CU Sleep
1207 South Mattis Avenue Champaign, IL 61821 (217) 355-1684
Christie Clinic Christie Clinic Cancer Center Photo Christie Clinic Cancer Center
109 West University Avenue Champaign, IL 61820 (217) 366-5180
Christie Clinic Convenient Care in County Market (Kirby & Duncan) Photo Convenient Care in County Market (Kirby & Duncan)
2901 West Kirby Avenue Champaign, IL 61821 (217) 366-8130
Christie Clinic Christie Clinic in Urbana/Convenient Care Photo Christie Clinic in Urbana/Convenient Care
1710 East Windsor Road Urbana, IL 61802 (217) 344-9440
Christie Clinic Christie Clinic in Danville on Logan Photo Christie Clinic in Danville on Logan
800 North Logan Avenue Danville, IL 61832 (217) 431-8930
Christie Clinic Christie Clinic on Fox Drive Photo Christie Clinic on Fox Drive
2110 Fox Drive, Suite B Champaign, IL 61820
Christie Clinic Christie Clinic in Monticello at Kirby Medical Group Specialty Clinic Photo Christie Clinic in Monticello at Kirby Medical Group Specialty Clinic
1109 B North State Street Monticello, IL 61856 (217) 366-1304
Gibson Area Hospital
1120 N Melvin Gibson City, IL 60936 (217) 784-2240
Christie Clinic Christie Clinic in Mattoon Photo Christie Clinic in Mattoon
105 B Professional Plaza Mattoon, IL 61938 (217) 345-3000
Christie Clinic Sarah Bush Lincoln Health System Photo Sarah Bush Lincoln Health System
1000 Health Center Drive Mattoon, IL 61938 (217) 258-2588
Christie Clinic The Champaign SurgiCenter Photo The Champaign SurgiCenter
1702 S. Mattis Avenue Champaign, IL 61821 (217) 326-2030
Christie Clinic The Carle Foundation Hospital Photo The Carle Foundation Hospital
611 West Park Street Urbana, IL 61801 (217) 383-3311
Iroquois Memorial Hospital
200 E. Fairman Ave. Watseka, IL 60970 (815) 432-5841
Christie Clinic Christie Clinic in Savoy Photo Christie Clinic in Savoy
501 North Dunlap Avenue Savoy, IL 61874 Transformations: (217) 366-7460 Internal Medicine: (217) 366-5434 Ophthalmology: (217) 366-1250
Christie Clinic on West Park Street
1405 West Park Street Urbana, IL 61801 217-366-1237
Christie Clinic in Monticello
107 West Main Street Monticello, IL 61856 217.762.3352
Christie Clinic Christie Clinic in Decatur Photo Christie Clinic in Decatur
100 South Water Street Suite 103 Decatur, IL 62523 217-362-0661- telephone
Christie Clinic Christie Clinic in Danville on Vermilion/Convenient Care Photo Christie Clinic in Danville on Vermilion/Convenient Care
3545 North Vermilion Street Danville, IL 61832 (217) 442-8611