Carotid Endarterectomy
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Carotid artery blockages cause up to half of strokes that happen in the U.S. every year. They happen when plaque builds up on the walls of your carotid arteries (carotid artery disease), which are in your neck and bring blood up to your brain. Plaque build-up blocks blood flow to your brain.
At UVA Health, we can prevent strokes by taking out this plaque with a carotid endarterectomy. This improves blood flow inside the carotid arteries.
Treating Carotid Artery Disease: UVA Health Expertise
We do about 120 carotid surgeries every year. Studies show that patients who have this surgery at hospitals that do more than 100 of them a year have better outcomes.
Our carotid surgery team includes vascular surgeons, heart doctors, neurologists, and imaging specialists.
Carotid Artery Disease
W. Darrin Clouse, MD, discusses the causes, symptoms, and treatment of carotid artery disease.
There are many different processes that can cause carotid artery disease, but by far the most overwhelmingly common is atherosclerosis, which is the same kind of biologic process that affects heart arteries, leg arteries, or other arteries throughout the body.
Atherosclerosis is a process whereby a blockage occurs, and that blockage in the carotid artery can predispose someone to stroke. If we find the blockage in the carotid artery, the narrowing is called a stenosis. If we find that stenosis and able to intervene, we reduce the patient’s long-term risk of stroke.
Patients who are most likely to suffer from carotid artery disease are patients who have risk factors for atherosclerosis: high blood pressure, coronary artery disease, high cholesterol, family history of having artery problems.
Generally, patients have the inability to move or feel their arm or leg. They may be unable to speak. They may have facial drooping. They also may have a condition of fleeting blindness. Those are all signs and symptoms of carotid artery disease that should be discussed with a doctor right away.
Carotid artery disease can be treated in one of generally three ways; medical management, in which patients are put on antiplatelet therapy, which is aspirin, and we have some newer antiplatelet agents.
Carotid artery stenosis has traditionally been treated in patients with significant stenosis by what’s called carotid endarterectomy. Clamps are placed on the carotid artery to stop the blood flowing through the carotid artery, and the plaque, or atherosclerotic build-up, is cleaned from the carotid artery. That’s what we have the most experience with. More recently, with endoluminal, or what’s called endovascular or less invasive techniques, carotid artery stenting has been performed.
There’s a newer treatment that involves carotid stenting, but it involves operating on the carotid artery in a way that’s less invasive. The outcomes of this newer, what’s called transcervical carotid artery stenting, or TCAR, are very similar to results of carotid endarterectomy, the traditional operation. And this is a novel way that the carotid artery is now treated in patients who might have a difficult operation, but now can have a less invasive operation.
What to Expect During a Carotid Endarterectomy
This surgery requires a hospital stay. You’ll get either general anesthesia or local anesthesia, depending on your needs.
During the procedure, your surgeon makes a cut in your neck over your diseased carotid artery. Then they create a bypass. This allows blood to flow around the area while they work on the artery.
They’ll then open the artery and remove plaque from the artery walls. This can take several hours. They'll be careful to keep fragments of plaque from breaking off and flowing downstream.
Once done, the surgeon closes the artery and the cut with sutures or staples. You can usually go home a day or two after the surgery.
After Carotid Endarterectomy
After your surgery, you’ll still need regular visits with your heart care doctor. They’ll help you with a care plan. They’ll monitor your heart and arteries to watch for plaque building up again.
Angioplasty and Stenting: When You Can’t Have Endarterectomy
Not every patient qualifies for carotid endarterectomy. If you can't have general anesthesia or if we can’t reach your plaque, carotid endarterectomy won’t work for you. Instead, we can perform an angioplasty and stenting procedure.
In this procedure, a surgeon puts a metal stent in your artery to keep it open.
Learn more about angioplasty and stenting.