Carotid Endarterectomy: Procedure, Indications & Recovery

Carotid endarterectomy meaning is a surgical procedure that treats carotid artery disease. This condition causes the narrowing of carotid arteries due to a buildup of fatty deposits of plaque. Reduced blood flow to the brain increases the risk of stroke. 

It removes plaques from the carotid arteries and restores normal blood flow to the brain. 

Anatomy and Physiology of Carotid Arteries

The carotid arteries are blood vessels located on each side of the neck. They begin in the upper chest and travel upward towards the skull. These are primarily responsible for supplying oxygen-rich blood to organs and tissues in the brain, neck, and face. The anatomy of these arteries is as follows: 

1. Left Common Carotid Artery: It branches from the aortic arch (the top portion of the main artery that carries blood from the heart). 

2. Right Common Carotid Artery: It branches from the brachiocephalic artery (the first branch of the aortic arch). 

These common carotid arteries bifurcate into two branches: 

1. Internal Carotid Artery: Divides into anterior cerebral and middle cerebral arteries. 

2. External Carotid Artery: Branches into internal maxillary and superficial temporal arteries.

The procedure is not suitable for every individual with carotid artery disease. It is generally recommended for those with moderate or severe narrowing (stenosis) of the carotid arteries. Carotid endarterectomy indications include: 

1. Symptomatic Patients: Individuals who have experienced symptoms of carotid artery disease like transient ischemic attacks (TIAs). Symptoms may include facial weakness, temporary loss of vision in one or both eyes or difficulty speaking. Surgery is advised if there is 50% or greater narrowing.

2. Asymptomatic Patients: These patients have not experienced symptoms but have been found to have significant carotid artery stenosis through screening. Surgery is considered if the stenosis is 70% or greater.

It is performed under general or local anaesthesia to ensure a painless procedure, which typically takes about two hours. The left or right carotid endarterectomy procedure involves the following steps: 

1. The surgeon makes a 4-inch incision down the side of the neck at the location of the clogged carotid artery. 

2. Once the carotid artery is exposed, an incision is made into the artery. 

3. Clamps are placed on the artery above and below the section affected by plaque to stop blood flow through this area. 

4. A tiny tube (shunt) is inserted to bypass the clamped section, maintaining blood flow to the brain during the procedure.

5. The surgeon removes the plaque deposit from the artery.

6. After the plaque is removed, the artery is often repaired with a patch of material to widen the artery and prevent narrowing as it heals.

7. The clamps are removed to restore blood flow through the artery.

8. The cut is closed with stitches and covered with a sterile bandage.

We provide detailed instructions to patients to prepare for the surgery. Closely adhering to these guidelines before and on the day of the procedure is essential for ensuring a successful surgery.

Before Carotid Endarterectomy

For planned surgeries, this phase is crucial to ensure you are prepared for the procedure. It includes arranging for post-operative care and transportation home. Other guidelines provided by your doctor for a smooth recovery process are as follows:

On the Day of Carotid Endarterectomy 

Understanding what to expect on the day of the surgery can help reduce anxiety and make patients feel more at ease. Arrive at the hospital at the scheduled time to complete final check-ups, which include the following:

It is normal to experience pain and swelling in the neck for up to two weeks after the surgery. Patients should follow their doctor’s instructions in the hospital and at home for a speedy and smooth recovery. 

In Hospital Recovery

Individuals who undergo carotid endarterectomy stay in the hospital for one to two days. During this period, they can expect the following: 

1. Immediately after the surgery, you are taken to a recovery room, where vital signs, such as blood pressure, oxygen, and heart rate, are monitored.

2. Once your condition stabilizes, you are moved to an ICU or a hospital room.

3. If a drainage tube is placed in your neck during the procedure, it is removed the next morning.

4. Pain medications are given to manage discomfort.

At-home Recovery

Once home, you can return to most of your normal activities, like work, within three to four weeks. However, you may experience numbness near the jawline and earlobe for about six months to a year. During the recovery period, it is important to follow these guidelines:

1. Wound Care: Clean the incision with mild soap and warm water. Avoid putting lotions on it. The scar usually diminishes to a fine line within two to three months. 

2. Pain Management: Take prescribed pain relievers to manage discomfort around the incision area. 

3. Diet: Maintaining a healthy diet is important. To promote vascular health, consume a low-cholesterol, low-fat diet high in fruits, vegetables, and lean meats. Avoid processed or packaged foods. 

4. Activity Restrictions: Avoid heavy lifting and driving for one to two weeks. 

First Follow-up Appointment

The first follow-up appointment after right or left carotid endarterectomy is scheduled within 1 to 2 weeks after surgery. This visit allows the surgeon to check the incision for proper healing and assess for any signs of complications. 

1. The next appointment is scheduled four to six weeks after surgery to remove any stitches. The doctor also performs a carotid Doppler ultrasound to evaluate blood flow through the artery. 

2. Next, the patient will visit their doctor six months after surgery and annually.  

The procedure offers significant procedural benefits that enhance the effectiveness and safety of treating carotid artery disease. These advantages include: 

1. Direct Plaque Removal: The procedure allows for the direct removal of plaque from the carotid artery. This reduces the immediate risk of stroke after carotid endarterectomy by one-third within three years following surgery.

2. Durable Results: The benefits of carotid are long-lasting. A study by Fahad et al. (2023) reports a three-year survival rate of 92.9% for individuals in their eighties who undergo CEA.

3. Minimally Invasive Options: While traditional open surgery is common, less invasive techniques such as eversion carotid endarterectomy are available. These techniques close the incision without a patch, reducing operative time.

4. High Success Rate: According to a study on women by Pasqui et al., carotid endarterectomy has an acute success rate of 100%.

Despite the benefits, it carries potential risks depending on the location of the blockage, the severity of the disease, and the individual’s age. Complications of the procedure are as follows: 

1. Infection 

2. Bleeding 

3. Blood clots 

4. Nerve Damage 

5. Stroke (in 5%-7% of people who had a previous stroke and 2%-3% who did not)

6. Heart attack 

7. Renarrowing of the artery 

When to call a doctor? 

After undergoing CEA, knowing when to seek medical attention is essential. Contact your doctor in the following situations:

1. Vision problems, headaches, confusion, difficulty speaking or understanding language 

2. Increasing redness or green or yellow discharge from the incision 

3. Chest pain or shortness of breath 

4. Difficulty swallowing 

5. Fever above 100.4°F

Delaying a carotid endarterectomy when recommended can increase the possibility of serious complications due to the progression of carotid artery disease. Here are some complications associated with postponing this surgery:

1. Increased Risk of Stroke: As plaque buildup progresses, it can narrow the carotid artery, reducing blood flow to the brain and causing a stroke. 

2. Embolic Stroke: A piece of the plaque can break off and travel to the brain, aggravating the risk of stroke.

3. Reduced Efficacy of Surgery: According to a study by Recarey et al., 2023, the risk of postoperative stroke is minimised when surgery is performed 3-4 days after suffering a stroke. Delay beyond five days does not reduce the stroke risk. 

Cost of Carotid Endarterectomy 

Due to several factors, the cost of carotid endarterectomy in India can vary widely. The price range is from ₹ 1,10,000 to ₹ 2,50,000, and the average expense is ₹ 1,30,000. 

Note: These figures are approximate. For accurate details, consult HexaHealth experts.

Factors influencing the cost of this surgery include:

1. Surgeon’s Expertise: Specialists with extensive experience and specialisation in vascular surgery may charge higher fees for their services.

2. Healthcare Facility: Private hospitals generally incur higher costs compared to public centers due to better amenities. 

3. Geographical Location: Urban areas and regions with higher living costs tend to have higher procedure expenses.

4. Pre- and Post-operative Care: Costs associated with pre-operative assessments (such as imaging and consultations) and post-operative care (including follow-up visits) also contribute to the overall expense.

Carotid endarterectomy is a surgical procedure that treats carotid artery disease and prevents stroke. By removing plaque from the carotid arteries, this surgery restores blood flow to the brain. It is especially crucial for those with severe stenosis or symptoms related to reduced cerebral blood flow.

If you seek treatment such as left carotid endarterectomy, choose a trusted partner like HexaHealth! Our network features experienced surgeons and healthcare facilities to ensure the best outcomes. From the initial consultation through recovery, we simplify the process, enhancing the treatment's success.