Carotid Endarterectomy

Carotid endarterectomy is a procedure whereby obstructing plaque is removed from the carotid artery. The purpose of the surgery is to prevent stroke. It is usually performed in patients with severe blockages in the carotid arteries who are experiencing mini-strokes or transient ischemic attacks (TIAs).

Preparation for surgery

Tests required before the operation include blood tests, chest X-ray, an ultrasound and CT scan of the carotid arteries. You will need to go to the Pre-Surgery Clinic at Trillium West Toronto and meet with an anesthetist before the operation. Ideally you should attempt to complete all these tests before the visit so the anesthetist can review the results with you. You also need to have a checkup with your family physician prior to surgery. You should take your surgical package to all the appointments. It is very important to continue taking blood thinners such as aspirin, Aggrenox or Plavix on the morning of surgery. 

What does the operation consist of?

Monitors are placed around your head before the operation in order to monitor your brain during the procedure. The operation is done under general anesthesia using electroencephalographic monitoring (EEG). An incision is made in the neck, the artery is opened and the plaque is removed. The artery is closed with a patch to prevent narrowing. 

What happens after the operation?

You will be cared for on the surgery ward overnight. You are allowed to have dinner and get out of bed the evening after the operation. Most patients are able to go home the next morning. You will have absorbable sutures. 

Recovery at home

You should shower and clean the incision with soap and water after the second day. You may remove the paper strips over the incision after 7 days. You may resume driving and normal activities immediately. You should continue taking all your usual medication including blood thinners. Your surgeon will arrange for you to have an ultrasound test and follow-up office visit about a month after your surgery. 

Complications

The risk of major complications with surgery is about 3%. This risk must be balanced against the risk of major stroke without surgery. Possible rare complications include death, major stroke, heart problems, bleeding, infection and nerve injury leading to difficulty swallowing.