Carotid Endarterectomy

What you should know

Carotid endarterectomy (CEA) is a surgery done to remove plaque (fatty deposits) from inside your carotid artery. The carotid artery is a blood vessel found in both sides of your neck. Plaque may build up inside your carotid artery and decrease blood flow to your brain. A piece of plaque may also break free and cause a stroke.


Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

  • During your CEA, muscles or nerves near your carotid artery may be damaged. Nerve damage may lead to changes in how you look, or trouble chewing and swallowing. You may bleed more than expected or get an infection. You may have headaches, increased blood pressure, and abnormal heartbeats. Swelling of your surgery site may occur, which could block your airway. A fistula (abnormal connection) may form, which connects your carotid artery to another tissue. You are also at risk of having a heart attack during or after surgery, and this can be life-threatening.

  • You may get a blood clot in your leg, arm, or carotid artery. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke. After a CEA, your carotid artery may become narrow or full of plaque again. The patch used for your surgery may tear or loosen, causing a large amount of blood loss. People who smoke, have diabetes, or kidney, lung, or heart disease are at a higher risk of problems. If you do not have the surgery, you are at risk for a stroke, which may be life-threatening.

Getting Ready

Before your surgery:

  • Ask your caregiver if you need to take aspirin or a blood-thinning medicine before your surgery. This medicine will help stop clots from forming in your blood.

  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.

  • Tell your caregiver if you have any other medical conditions, such as diabetes or heart, lung, or kidney disease.

  • Your caregiver may have you do certain tests to check your brain function. You may be asked to draw, memorize and remember items, or do certain movements.

  • You may need to have blood tests done before your surgery. Imaging tests, such as an ultrasound, a CT scan, or MRI, may also be done. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the caregiver if you have any metal in or on your body. The imaging tests may be done to check the plaques in your carotid artery. You may also need an angiography to check the blood flow from your carotid artery to your brain. Write down the date, time, and location of each test.

  • Write down the correct date, time, and location of your procedure.

  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

The night before your surgery:

  • Ask your caregiver about directions for eating and drinking.

The day of your surgery:

  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

Treatment

What will happen:

  • You will be given anesthesia to keep you free from pain during your surgery. Your blood pressure, temperature, and heart rate will be monitored during surgery. Your skin over your carotid artery will be cleaned. An incision is made to open your neck and reach your carotid artery. Your carotid artery may be clamped in certain areas to stop your blood from flowing through it. Your carotid artery will then be cut open and the plaque will be removed.

  • Once the plaque is removed, your artery will be closed or put back together with stitches. A man-made patch or a piece of your own vein may also be used to close your artery. The clamps will be removed and the blood flow through your carotid artery will be checked. A drain may be put under your skin to remove extra blood and fluid from around your artery. Your skin will be closed with stitches and covered with a bandage. The bandage will help keep your surgery area clean and dry to prevent infection.

After your surgery:

You may be taken to a recovery room or your hospital room where caregivers will check you often. You may be attached to monitors that your caregivers can watch outside your room. Caregivers may remove your bandage soon after your surgery to check your incision. Your head will be kept straight for 24 hours after surgery to reduce side effects, such as swelling and fainting The head of your bed may also be slightly raised. Do not get out of bed until your caregiver says it is okay.

Contact a caregiver if

  • You have a fever, vomiting, diarrhea, or other signs of illness.

Seek Care Immediately if

You have any of the following signs of a stroke:
  • Numbness or drooping on one side of your face

  • Weakness in an arm or leg

  • Confusion or difficulty speaking

  • Dizziness, a severe headache, or vision loss

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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