What Is Carotid Artery
The carotid arteries, which are located on either side of your
neck, provide your brain with the oxygen-rich blood it needs to function
properly. Without this blood flow, your brain cells would die. When blood flow
to an area of the brain is restricted or blocked, it may lead to a stroke.
Strokes may cause temporary or permanent mental and physical impairment, and
can be fatal.
If you have carotid artery disease, a substance called plaque
builds up in your passages and restricts the flow of blood. If the deposits of
plaque — which are composed of compounds such as fat and cholesterol — are
significant enough, they can cut off blood flow to the brain and cause a
A surgery called carotid endarterectomy (CEA) is one way to
remove blockages to the normal flow of blood and to minimize your risk of a
stroke. A CEA is also known as carotid artery surgery.
Purpose of Carotid Artery
Carotid artery blockages can cut off blood to the brain and can
lead to a stroke. These blockages can be caused by plaque, or by a blood clot
that has clogged the artery. By performing a CEA, your doctor is trying to keep
blood flowing to your brain in order to prevent strokes.
Carotid artery surgery also helps prevent a transient
ischemic attack (TIA). A TIA has the symptoms of a stroke — such as
numbness, difficulties with speech or vision, and trouble walking — but they
last for a brief time. According to the National
Institute of Neurological Disorders and Stroke, symptoms of a TIA
usually disappear within an hour. Like a stroke, a TIA is caused by a temporary
blockage of blood to the brain.
Your doctor might recommend CEA if you meet certain criteria,
- you’ve already had a stroke
- you’ve already had a TIA
- the blockage of your carotid artery is severe
Preparing for Carotid
In the days before the surgery, your doctor may want to conduct
tests that will give them a better picture of your arteries. Tests used to
prepare for a CEA include:
- carotid ultrasound: sound waves are used to
create a picture of the artery
- carotid angiography: an X-ray uses dye to
highlight the artery, making the blockages more visible
- magnetic resonance angiography (MRA): magnetic
and radio waves create a picture of the artery, sometimes with the use of
contrast dye to get a clearer image
- computed tomography angiography: X-rays provide
a 3D picture of the arteries, sometimes using dye as well
The CEA Procedure
The surgery will take place at a hospital and usually takes a
few hours. There are two versions of the CEA.
In the first type of procedure, your surgeon will cut
into the artery and remove the blockage. You will receive anesthetic, though it
might be only a local anesthetic that numbs the specific part of your neck. The
surgeon may decide to use a local anesthetic if they want to speak with you
during the procedure to see how your brain is responding.
The artery that is being cleared will be clamped during the
surgery, but blood will still reach the brain through the carotid artery on the
other side of your neck. A tube might also be used to reroute the blood flow
around the artery receiving surgery.
In the second type of CEA, the section of the
artery that has problems with plaque is turned inside out. The plaque is
cleared away and then the artery is put back in its normal position. The
technical term for this is eversion carotid endarterectomy.
Once the blockage is removed, the artery is stitched back
together and unclamped and the opening in your neck is closed with stitches.
You may need to have a drain in your neck to remove any fluid that has built
After Carotid Artery Surgery
Recovery time varies and you may need to stay in the hospital
overnight for monitoring. Your doctor will want to be sure that you don’t have
any bleeding, poor blood flow to your brain, or other possible risk factors for
a stroke. However, if your surgery was in the morning and you are doing okay,
you may not need to stay the night.
There might be some soreness in your neck, or it may be hard to
swallow. Your doctor might put you on pain medication and may also prescribe an
anticlotting medication, like aspirin, for a while to minimize the risk of
CEA is considered a reasonably safe procedure that can greatly
reduce the risk of stroke if you have carotid artery disease. The procedure
does carry some risk of stroke or even death. Other diseases like diabetes can
also complicate the procedure.
It is important to thoroughly discuss your options with your
doctor before making the decision to have this procedure.
A carotid angioplasty is another surgical alternative to a CEA.
During this procedure, a slender tube is inserted into the artery, and a
portion of the tube is inflated to remove the buildup in your artery.
The inflated balloon pushes the plaque deposit out of the way,
reopening the pathway. The surgeon might also insert a small metal tube called
a stent, which is designed to keep the pathway from becoming blocked in the
future. You might also be put on a regimen of anticlotting medications to make
it harder for your blood to clot. This also minimizes the chance of a stroke