What is carotid endarterectomy?

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise. Your doctor will tell you when it's okay to do strenuous activity.
• For at least 2 weeks, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Ask your doctor when you can drive again.
• You may need to take 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.
• Your doctor will tell you when you can have sex again.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
• Eat a heart-healthy diet. If you have not been eating this way, talk to your doctor. You also may want to talk to a dietitian. A dietitian can help you plan meals and learn about healthy foods.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• If you take a blood thinner, such as aspirin, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape over your incision, leave the tape on for a week or until it falls off.
• You may shower and take baths as usual. But do not soak the incision for the first 2 weeks, or until your doctor tells you it is okay. Pat the incision dry.
• Wash the area daily with water and pat it dry. Other cleaning products, such as hydrogen peroxide, can make the wound heal more slowly. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

If you have not had a TIA or stroke

For people who haven't had a stroke or TIA, it's not clear when endarterectomy might be a good choice. The surgery may help prevent a stroke in the long run. But in the short term, it increases the risk of stroke and death. Medicine and a heart-healthy lifestyle may work as well as surgery to prevent a stroke. And they don't have the risks of surgery.

It's not clear that this surgery will reduce your stroke risk more than medicines and lifestyle changes alone. Studies are being done to compare current medical therapy with endarterectomy.

If you've had a TIA or stroke

An endarterectomy can help lower your risk of stroke if your carotid artery is narrowed by 50% or more. People with less than 50% narrowing do not benefit from surgery.

You may benefit most from endarterectomy if it is done within 2 weeks of the stroke or TIA.

The surgery takes about an hour.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

The risks of carotid endarterectomy include:

• Infection.
• Nerve damage that could cause serious problems, like trouble swallowing.
• Bleeding in the brain or neck.
• Stroke, heart attack, or death.
• The artery can narrow again.

The risks of a procedure depend on things like your age and your overall health. Who does the procedure and where it is done are also important.

You may stay in the hospital for at least a day or two.

You may have a sore throat for a few days. You can expect the incision to be sore for about a week. The area around it may also be swollen and bruised at first. The area in front of the incision may be numb. This numbness usually gets better after several months.

You may feel more tired than usual for several weeks after surgery. You can do light activities around the house. But don't do anything strenuous until your doctor says it is okay. This may be for at least 2 weeks.

You will have regular tests to check blood flow in your carotid arteries.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. You may be asleep, or you may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
• The surgery may take about 2 hours.

Carotid endarterectomy is done to help lower your risk of stroke.

Your doctor may recommend this procedure based on certain things. These include:

• The amount of narrowing (stenosis) in your carotid arteries. A procedure may be an option if the narrowing is 50% or more.
• Whether you had a stroke or TIA within the past 6 months. If you have not had a stroke or TIA, it's less clear that the procedure will help you.

Your doctor can help you understand your risk of stroke and whether endarterectomy might be an option for you.