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Preparing for Carotid Endarterectomy

Carotid endarterectomy removes plaque that has built up in your carotid artery. This helps reduce your risk of a stroke. You will be told how to prepare for your surgery. Be sure to follow all of the instructions you are given.

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Tests before surgery is planned

You will have one or more tests to determine the extend of your carotid artery disease.

These include:

  • Carotid ultrasound. An ultrasound of your carotid arteries uses sound waves to get pictures of inside your carotid arteries.

  • Carotid angiography. A special X-ray that reuires a small tube placed in your groin artery to inject dye into your carotid arteries to get a better picture of the insid eof your carotid arteries.

  • Magnetic resonance angiography (MRA). Pictures of your carotid arteries are made with a large magnet which can also be done with dye through the IV line to increase the clarity of the picures.

  • Computed tomography (CTA). This test uses sound waves from many different angles of your carotid arteries and can also be done with dye to increase the picture quality.

A week or more before

 

  • You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if something is not clear.

  • Tell your doctor if you are sensitive to or are allergic to any medidcations, iodine, latex, tape, contrast dye, or anesthetics.

  • Tell your doctor of all your medications (prescription and over-the-counter) and herbs and supplements that you take.

  • Tell your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications prior to the surgery.

  • If you are pregnant or think you may be, tell your doctor.

  • Tell your doctor if you have a pacemaker.

  • If you smoke, stop smoking as soon as possible prior to the surgery. This may improve your chances for a successful recovery from surgery and benefit your overall health status, as smoking increases clot formation in the blood.

  • Based on your medical condition, your doctor may request other specific preparation.

The day Before

  • Your hospital stay may be one or two days. Arrange for an adult family member or friend to drive you home.

  • Don’t eat or drink after midnight, the night before the surgery. (Ask your doctor whether you should continue to take any medications during this period.)

  • Follow any other instructions you are given.

On the day of the procedure

Generally, a carotid endarterectomy (CEA) follows this process:

  1. Your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.

  2. You will be asked to remove any jewelry or other objects that may interfere with the procedure.

  3. You will be asked to remove your clothing and will be given a gown to wear.

  4. You will be asked to empty your bladder prior to the surgery.

  5. An intravenous (IV) line will be started in your arm or hand. An additional catheter will be inserted in your wrist to monitor your blood pressure, as well as for taking blood samples. One or more additional catheters may be inserted into your neck, opposite the surgery site, to monitor your heart function. Alternate sites for the additional catheter include the subclavian (under the collarbone) area and the groin. You may receive a sedative prior to the surgery to help you relax.

  6. If there is excessive hair at the surgical site, it may be shaved off.

  7. You will be positioned on the operating table, lying on your back, with your head raised slightly and turned away from the side to be operated on.

  8. A catheter will be inserted into your bladder to drain urine.

  9. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

  10. CEA may be done using local anesthesia. You will be sleepy, but will not feel the area being operated on. You will receive a sedative medication in your IV before the surgery to help you relax. However, you will remain awake, but sleepy, during the surgery. This allows the doctor to monitor how you are doing during the surgery by asking you questions and testing your hand grip strength.

  11. If the CEA is done under local anesthesia, the doctor will provide constant support and keep you comfortable during the surgery. Pain medicine will be given.

  12. Under local anesthesia, you will receive oxygen through a nasal cannula, a tube that fits in your nose.

  13. You will be given a dose of antibiotics through your IV to help prevent infection.

  14. The skin over the surgical site will be cleansed with an antiseptic solution.

  15. The doctor will make an incision down the side of the neck over the diseased artery. Once the carotid artery is exposed, the doctor will make an incision into the artery.

  16. The doctor may use a device called a shunt to divert blood flow around the surgical area to maintain blood flow to the brain. A shunt is a small tube that is inserted into the carotid artery to deliver blood flow around the area being operated on.

  17. With the blood flow diverted, the doctor will remove the atherosclerotic plaque from the artery.

  18. The shunt will be removed and the artery will be closed. The incision in the neck will be sutured together.

  19. A drain may be placed in your neck. The drain is a small tube that is inserted in the neck to drain any accumulation of blood into a small palm-size suction bulb., It is generally removed the morning after the procedure.

  20. You may receive blood pressure medication through your IV during and after the procedure to keep your blood pressure within a certain range.

  21. If you received general anesthesia, the anesthesiologist will wake you up in the operating room to be sure you can respond to questions.

  22. A sterile bandage or dressing will be applied.

Risks and possible complications of carotid endarterectomy

  • TIA or stroke (this is a low risk about 1% to 3%)

  • Bleeding at the incision site

  • Heart attack

  • Temporary or permanent hoarseness, numbness, or swallowing problems

  • Wound infection

  • Difficulty closing your mouth

  • Asymmetry in your face when you smile

The change of any of these unusual complications is much less than the risk of stroke if significant carotid blockage is not treated.

 

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