Carotid artery disease can put anyone at risk for a life-threatening stroke. For decades, surgeons have used carotid endarterectomy to reliably treat carotid blockages.
Many people with severe carotid artery disease are candidates for carotid endarterectomy, an open surgery to clear carotid artery blockages. It can reduce your risk of stroke and transient ischemic attack (TIA) or mini-stroke.
What Is Carotid Endarterectomy?
Carotid endarterectomy is an open surgery to treat carotid artery disease. Carotid artery disease, or carotid artery stenosis, occurs when a buildup of plaque begins to block one of the carotid arteries. Plaque is a fatty substance that sticks to your artery walls.
The carotid arteries are large vessels that carry blood to your brain. As they become narrowed or blocked, blood flow decreases. Blockages also increase the chance of blood clots forming. If a clot breaks loose and travels to your brain, it can cause a stroke that damages your brain.
In a carotid endarterectomy, a vascular surgeon opens and cleans out the artery to reduce your risk of stroke. Surgeons have used the procedure safely for decades.
Carotid Endarterectomy vs. Eversion Endarterectomy
Penn vascular surgeons use two approaches to carotid artery surgery. The procedures are similar, but having both options enables your surgeon to choose the one that meets your particular needs.
- Traditional carotid endarterectomy involves an incision along your carotid artery. It enables your surgeon to more easily use a shunt, a tube to keep blood flowing to your brain during surgery. The surgeon closes the artery with a patch from another blood vessel in your body or a synthetic material.
- Eversion endarterectomy uses an incision that crosses the carotid artery. Your surgeon can close the incision without a patch, which reduces the chance of carotid artery disease re-occurring in the future. Not all surgeons at other hospitals have the skill to perform eversion endarterectomy.
Carotid Angioplasty and Stenting
Some people aren't good candidates for open surgery. The surgery may be too great a risk for their overall health. In these cases, we can perform carotid angioplasty and stenting or transcarotid artery revascularization (TCAR).
The surgeon uses a catheter (a long, flexible tube with a camera and tools at the end) inserted through a small puncture in your groin. After threading the catheter to the blockage, the surgeon clears your carotid artery. Then the surgeon places a stent (a small wire mesh tube) to hold the artery open and keep blood flowing.
Carotid Endarterectomy for Carotid Artery Disease: The Penn Medicine Difference
Treating carotid artery disease requires expertise to recommend the right treatment for you — and deliver that treatment safely and effectively. We take time to discuss your options and ensure that you and your family are comfortable with your options and outlook. At the Penn Vascular Surgery and Endovascular Therapy Program, you'll also find:
- Deep experience: As a national leader in the treatment of carotid artery stenosis and stroke prevention, Penn vascular surgeons have performed more carotid interventions than any other medical center in the region. We treat more than 200 people each year, a high number, and have an exceptionally high success rate.
- Renowned expertise: Doctors from around the region refer patients with challenging carotid artery conditions to us for treatment.
- Full range of options: When your Penn physician evaluates your case, you'll know you have access to every available option. In addition to carotid endarterectomy, your options include minimally invasive carotid angioplasty and stenting and transcarotid artery revascularization (TCAR).
How Is Carotid Endarterectomy Surgery Performed?
A carotid endarterectomy is a surgical procedure. You'll have it in the hospital. Your care team includes vascular surgeons, nurses, technicians and a vascular anesthesiologist. During the procedure:
- You may have local anesthesia and sedation, or you may have general anesthesia (to put you to sleep). Our dedicated vascular anesthesiologist will monitor your well-being throughout the procedure.
- Your surgeon makes an incision in your neck to access the artery. Your doctor may place a shunt, a tube that diverts blood flow around the blocked artery to send blood to your brain.
- The surgeon removes the plaque from the artery. They may place a stent (a tiny wire mesh tube) to hold open the artery.
- The surgeon stitches closed the artery and the incision. You may have a drain, a small tube to let extra blood and fluids drain from your neck. Your health care team will remove the drain, usually the next day.
Most people stay in the hospital for a day or two after a carotid endarterectomy. After you go home, you can usually resume typical activities within a few days. You will have a sore throat and stiff neck for a week or two.
Your doctor will talk with you about your stroke risk. You may take medications or follow a special diet to reduce the risk of plaque building up again in your carotid artery.
You will have a carotid ultrasound after the procedure. You may repeat this procedure every year to watch for plaque buildup. We perform this test, called carotid intima-media thickness (CIMT), at our vascular testing and diagnosis labs.
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