Approximately 80% of all strokes occur due to disease in the carotid arteries, the pulsatile structures on both sides of the neck which provide most of the blood supply to the brain. As in almost all cases of disease in arteries throughout the body, the risk factors for plaque (atherosclerosis) build-up and narrowing of the carotid arteries include tobacco abuse, uncontrolled high blood pressure, diabetes, high cholesterol and a high fat diet. Rarely, genetics and certain inflammatory conditions play a role. Because the plaque causes narrowing of the artery, blood clots can form or debris can be sent downstream into the brain, which can cause mini-strokes (temporary neurologic events) or full-blown strokes (major, long-lasting neurologic disability).
A Carotid Endarterectomy is a surgical procedure performed under general anesthesia, whereby an incision is made transversely in a skin crease in the neck and the carotid artery is cleared of all dangerous plaque. The surgery takes about an hour, frequently a drain is left in place, a plastic surgical cosmetic closure is used, and most patients stay overnight in the hospital and go home the next day, barring any unforeseen medical problems.
The risks of this operation include, but are not limited to, stroke, heart attack, never damage and death….with a combined complication rate of about 2% and a mortality rate of about 1%. Most deaths are related to underlying heart disease, and therefore all patients are carefully evaluated for such hidden problems ahead of time.
After surgery, the only activity restriction is avoidance of driving a car for a week. By day 2 post-op, most patients can bathe, shower, climb stairs, walk outside…effectively resume their normal activities. Follow-up in the office is at about 7-10 days for suture removal, with an ultrasound of the carotid artery in about a month, followed by serial scans every 6-12 months long term to assure patency. About 5-10% of these arteries clog up again over time, either early on from scar tissue or over a period of years from recurrent atherosclerosis.