Disease of the carotid artery usually is most severe at the point in the neck where the artery divides in 2 (giving internal and external carotid arteries). When the artery gets narrowed at this point it may ultimately cause stroke, with the risk being highest in patients who have recently suffered a stroke or mini-stroke related to this narrowing. Depending on the degree of narrowing and the patient and symptoms surgery may be recommended.
The operation is usually performed under general anaesthetic and an incision is made at the side of the neck. The common carotid artery and it’ s major branches are exposed and controlled, clamped and opened. While this is being performed, sometimes a temporary tube is used to keep blood flowing to the brain on the operated side (known as a shunt) but this is not always necessary (Figure 1). The lining of the blood vessel responsible for the narrowing is removed, including the atherosclerotic plaque (Figure 2). The artery, once cleared of the diseased lining is closed and blood flow restored. Close monitoring of blood pressure, neurological function and of the surgical site is required in the initial post-operative period; the recovery time prior to discharge is usually 4-5 days.
Specific Risks of Carotid Endarterectomy
- Haematoma (bleeding in the wound) postoperatively requiring further surgery.
- Stroke or Death 2-3%
- Nerve injury causing difficulty with talking or swallowing, drooping of the mouth on one side, or hoarseness.
Intraoperative image of carotid endarterectomy procedure.
Close up view at atherosclerotic plaque removed at the time of carotid endarterectomy