Is Carotid Endarterectomy High-Risk Surgery?

Reviewed on 3/28/2022
Is Carotid Endarterectomy High-Risk Surgery
Carotid endarterectomy is a medium- to high-risk surgery, with fatality rates ranging from 0.5%-9%. However, it is considered a safe treatment option even for high-risk patients

Carotid endarterectomy is a medium- to high-risk surgery, with fatality rates ranging from 0.5%-9%. Most procedures that have a major impact on blood vessels and circulation and hemodynamics carry more risk. 

However, carotid endarterectomy is considered a safe treatment option even for high-risk patients, such as those who are over 80 years of age with comorbid diseases.

What is carotid endarterectomy?

Carotid endarterectomy involves the surgical removal of plaque from the carotid arteries and is used to treat carotid artery diseases. 

Located on either side of the neck, carotid arteries transfer oxygen-rich blood to the brain and face. When they do not function properly, plaque made up of fat, calcium, and cholesterol compounds are deposited on the carotid artery walls and restrict blood flow through the artery. Narrowing of the arteries is referred to as stenosis.

In some cases, plaque can break loose and travel to other small arteries in the body. If an embolism occurs, it can completely cut off the blood supply to the brain and cause stroke.

During carotid endarterectomy, plaque buildup in the arteries is removed to restore normal blood flow to the brain. 

Carotid endarterectomy is recommended in cases where patients have suffered from a stroke, a transient ischemic attack, or a blockage in the carotid artery that is severe but not complete.

How is a carotid endarterectomy performed?

Before the surgery

Tests may be ordered to procure a clearer picture of the arteries:

  • Carotid ultrasound (sound waves that create an image of the artery and assess blood flow)
  • Carotid angiography (invasive X-rays that use dyes to highlight the artery and make blockages visible)
  • Computed tomography angiography (uses dyes to create a three-dimensional picture of the artery using dyes)
  • Magnetic resonance angiography (X-rays and magnetic waves that create a clear picture of the arteries)

Before surgery, the patient is advised to stop taking certain medications including herbal supplements or nonsteroidal anti-inflammatory drugs. Tobacco products should also be stopped.

During the surgery

Carotid endarterectomy takes several hours to perform and is done under general or local anesthesia. Typically, local anesthesia is administered when the surgeon wants to check how the brain responds during the procedure. Below are the steps of the procedure:

  • A 4-inch incision is made in the neck at the site of the blockage.
  • Using a tiny tube, blood flow around the blockage is temporarily rerouted, and the area may be narrowed and isolated as well.
  • The plaque is carefully removed, fluid is drained, and the artery is stitched and unclamped.
  • A patch is used to widen the artery and to prevent narrowing of the artery in the future.
  • Blood flow to the brain is restored.

Patients can discuss with their surgeon regarding different patch materials to be used. For example, the saphenous vein can be used as a patch. In such cases, another incision is made in the leg. A bovine pericardial patch that comes from the lining of a cow's heart can be used as a patch as well. In some cases, synthetic materials are used as patches, although this increases short-term or long-term infection risks.

After the surgery

Patients must stay in the hospital overnight and are monitored for blood flow and potential complications. 

After surgery, the patient may experience numbness, swelling, bruising, or difficulty swallowing in the part of the neck where surgery was done. Patients are advised to avoid strenuous physical activities for 2-3 weeks. 

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What are the risks of carotid endarterectomy surgery?

Although carotid endarterectomy is generally considered safe, it carries some risks and in extreme cases can result in death (0.6%-9.6% of cases). Underlying health conditions such as diabetes, high blood pressure, and other heart conditions can complicate the recovery period.

Other potential complications of carotid endarterectomy include:

What is the aftercare for carotid endarterectomy?

After surgery, measures should be taken to keep the incision area clean and dry. During follow-up visits, the stitches are removed. If adhesive strips were used, the strips fall off on their own within a few days.

Patients are typically recommended to eat a healthy diet that is low in fat and cholesterol. If the any of the following symptoms are observed, medical care should be sought immediately:

  • Loss of sensation, tingling, or weakness in one side of the body
  • Blurred or double vision
  • Slurred speech or difficulty speaking
  • Difficulty breathing
  • Severe headache
  • Increased pain and swelling at the incision site
  • Redness 
  • Fever

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References
Image Source: iStock Images

Boules TN, Proctor MC, Aref A, Upchurch GR Jr, Stanley JC, Henke PK. Carotid endarterectomy remains the standard of care, even in high-risk surgical patients. Ann Surg. 2005;241(2):356-363. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356923/

DaCosta M, Tadi P, Surowiec SM. Carotid Endarterectomy. [Updated 2021 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK470582/ UCLA Health. Risk Stratification. https://www.uclahealth.org/anes/risk-stratification

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