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Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow.
As you age, plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your carotid arteries, or to cause irregularities in the normally smooth inner walls of the arteries.
Your carotid arteries are located on each side of your neck and extend from your aorta in your chest to enter the base of your skull. These important arteries supply blood to your brain.
Carotid artery disease is a serious issue because clots can form on the plaque. Plaque or clots can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to your brain sufficiently, it can cause an ischemic stroke, which can cause permanent brain damage, or death, if a large enough area of the brain is affected. If a clot or plaque blocks only a tiny artery in the brain, it may cause a transient ischemic attack (TIA), also known as a mini-stroke. A TIA is often a warning sign that a stroke may occur in the near future, and it should be a signal to seek treatment soon, before a stroke occurs.
To remove plaque in your carotid arteries and help prevent a stroke, your physician may recommend a carotid endarterectomy. Carotid endarterectomy is one of the most commonly performed vascular operations, and is a safe and long-lasting treatment.
When is the Procedure Indicated?
Physicians perform endarterectomy based on assessments of the blockage caused by plaque in a carotid artery and by considering other factors, such as history of TIA or prior stroke and the status of other vessels supplying blood to the brain in each person.
Treatments
Your doctor will recommend treatment based on your symptoms, medical history, and the severity of your carotid artery narrowing. Doctors usually treat people who have carotid artery narrowing of less than 70\% with blood-thinning medicines.
If you have a severe narrowing of the carotid artery or symptoms of a stroke or TIA, your doctor may recommend surgery to remove the plaque from your carotid artery. This type of surgery is called carotid endarterectomy. If your artery has become completely blocked, no medical or surgical treatment is available to unblock it.
A carotid angioplasty may be another option for some individuals at high risk for carotid endarterectomy surgery. In this procedure an expanding balloon is used to open the artery.
Procedure
In the days leading up to your procedure: arrange for a ride to and from the hospital and for help at home as you recover. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, herbs, or dietary supplements, your doctor may recommend temporarily discontinuing them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor
Before the procedure, an intravenous line will be started. A carotid darterectomy is usually done under general anesthesia, which will put you to sleep for the duration of the procedure. In this case, a breathing tube will be inserted through your mouth and into your windpipe to help you breathe during the operation.
Sometimes a carotid endarterectomy is done with local anesthesia. If local anesthesia is used, you will remain awake, but your neck will be numbed. You will probably also receive some sedation.
The surgeon will make an incision along your neck on the side of the blocked artery. The incision may run from just behind the ear to a point above the collarbone.
Your surgeon will find the carotid artery and temporarily clamp off blood flow through it. Your surgeon may place a shunt or temporary bypass to keep blood flowing to the brain.
Your surgeon will open up the artery and remove the plaque. After the blockage has been removed, he or she will sew the artery back together, usually placing a patch in the artery to widen it slightly. The patch may be made of part of one of your veins, or an artificial material, such as Dacron.
Finally, your surgeon will close the incision with sutures or staples and cover it with bandages. A temporary drain is frequently left in the wound.
Carotid Artery Disease Increases The Risk For Stroke In 3 Ways : -
By fatty deposits called plaque severely narrowing the carotid arteries.
By a blood clot becoming wedged in a carotid artery narrowed by plaque.
By plaque breaking off from the carotid arteries and blocking a smaller artery in the brain (cerebral artery).
Possible Complications
Although carotid endarterectomy is effective in reducing the likelihood of future strokes, there is a risk of serious complications such as stroke during the procedure. This risk can range between one and three percent.
Another recognized risk of carotid endarterectomy is injury to the nerves on the neck. In most cases, nerve dysfunction may be temporarily caused by swelling or stretching and clears up on its own within two weeks.
Factors that increase the risk of complications include : -
Extensive arterial blockage in other blood vessels
Poorly controlled hypertension
Prior stroke on either side of the brain
Diabetes.
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Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow. 
