Carotid Endarterectomy for TIA and Stroke
- A small incision is made in the neck just below the level of the jaw. The narrowed carotid artery is exposed.
- The blood flow through the narrowed area may be temporarily rerouted (shunted). Rerouting is done by placing a tube in the vessel above and below the narrowing. Blood flows around the narrowed area during the surgery.
- The artery is opened and the plaque is removed, often in one piece.
- The shunt is removed, and the artery and skin incisions are closed.
What To Expect After Surgery
The surgery takes about an hour. You will likely stay one night in the hospital.
Normal activities can be resumed within a week as long as the activities are not physically demanding. There may be some aching in the neck for up to 2 weeks.
Why It Is Done
- You have had a mild stroke or one or more transient ischemic attacks (TIAs) in the past 6 months and you have 70% or more narrowing in your carotid artery.
- You have a low risk of complications from the surgery.
- You have 50% to 69% narrowing and have had at least one of
- One or more TIAs in the past 6 months.
- A series of small strokes in the past 6 months, and each small stroke has left you a little more disabled.
- A mild or moderate stroke in the past 6 months.
- You have not had a TIA or stroke but you have at least 70% narrowing in your carotid artery.
How Well It Works
If you have had a TIA or stroke
You are most likely to benefit from surgery if you have had symptoms and if your carotid artery is narrowed by 70% or more. People with less than 50% narrowing do not seem to benefit from surgery.footnote 3
Carotid endarterectomy works better than treatment with medicine alone in preventing stroke for people who have symptoms that can be attributed to a 70% to 99% blockage of the carotid arteries.footnote 1
If you have not had a TIA or stroke
If you have not had a TIA or stroke, it is not as clear when endarterectomy might be a good choice. Medicine and lifestyle changes may work as well as surgery to prevent a stroke. Your doctor might recommend an endarterectomy if you have more than 70% narrowing and you have a low risk of having a serious problem from the surgery.footnote 2
The major risks linked with carotid endarterectomy are:
- Heart attack.
- Breathing problems.
- High blood pressure.
- Injury to nerves (usually causing vocal cord paralysis and problems with managing saliva and tongue movement).
- Bleeding in the brain.
What To Think About
Carefully weigh the benefits and risks of surgery, and compare them with the benefits and risks of medicine therapy. The success of medicine therapy will depend on how much narrowing (stenosis) is present in the arteries and the choice of medicine. Risks of surgery depend on your age, your overall health, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.
Carotid endarterectomy can be done several months after a stroke or TIA. But people benefit most from the surgery if it is done within 2 weeks of the stroke or TIA. Delaying surgery longer than 2 weeks increases the risk for stroke, because people are more likely to have a stroke in the first few days and weeks after a first stroke or a TIA.
The likelihood of complications from carotid endarterectomy varies, depending on the skill and experience of the surgeon. If you have had a TIA or stroke, the American Heart Association and American Stroke Association recommend that surgery be done by a surgeon who has complications in less than 6% of the endarterectomy surgeries that he or she performs and that the hospital rate of complications be just as low.footnote 1 If you have not had a stroke or TIA, it's important that you have a low risk (less than 3%) of serious problems.footnote 2
- Before surgery, any medical condition that increases the risk for stroke, such as high blood pressure or heart disease, needs to be controlled.
- The benefits of surgery may be temporary if disease or causes are not also treated. Make healthy lifestyle changes, and take medicines to lower your risk of problems.
- Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.
- Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.
- Rerkasem K, Rothwell PM (2011). Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database of Systematic Reviews (4).
Current as of: February 20, 2015