A carotid endarterectomy will either be carried out under general or local anaesthesia.
Anaesthetic
Anaesthetic is painkilling medication that allows surgery to take place without a patient feeling any pain or discomfort.
If you have a general anaesthetic, you will be asleep throughout the procedure. If you have a local anaesthetic, you will remain conscious but the area on your neck will be numbed so that you cannot feel any pain
Studies comparing the results of carotid endarteretctomies found no difference between the two types of anaesthetic. Therefore, it will be up to you, your surgeon and your anaesthetist (specialist in anaesthesia) to decide which type of anaesthetic to use.
However, your surgeon may prefer to use local anaesthetic so that you remain conscious during the operation. This will allow them to monitor your brain’s reaction to the decreased blood supply throughout the procedure.
The procedure
A carotid endarterectomy usually takes one to two hours to perform. If both of your carotid arteries need to be unblocked, two separate procedures will be carried out. One side will be done first and the second side will be done a few weeks later.
Once you are asleep, or the area has been numbed, your neck will be cleaned with antiseptic to stop bacteria getting into the wound. If necessary, the area may also be shaved. A small incision will then be made to allow the surgeon to access your carotid artery.
During the procedure, your surgeon will decide whether to use a temporary plastic shunt to maintain adequate blood flow to the brain. The decision to use a shunt is based on surgeon preference and the results of brain blood flow monitoring during the operation.
The carotid artery is clamped and an opening made across the length of the narrowing. If a shunt is to be used, it will be inserted now. There are two different ways of removing the narrowing:
- eversion endarterectomy
- traditional endarterectomy
There is no difference in terms of the outcome and the decision about which one to use will be made by your surgeon, who will usually have a preference.
Once the narrowing has been removed, the surface will be checked to ensure it is clear of any residual disease. The opening in the artery will then either be closed with a running suture (primary closure) or by using a patch. At present, the majority of surgeons in the UK use a patch but the choice is down to surgeon preference.
Your surgeon will then check for any bleeding. After any bleeding has stopped, the incision in your neck will be closed. A small tube (drain) may be left in the wound to drain away any blood that might build up after the operation. The tube will usually be removed the following day.
Risks
As with all types of surgery, there are some risks associated with carotid endarterectomy, including a small risk of having a stroke.
Before you have the operation, your surgeon will discuss your risk of having a stroke during or after the procedure. In general, it should be less than 3% for people who have not reported any prior symptoms, with 6% being the accepted threshold of risk for patients who present with a stroke or transient ischaemic attack (TIA).
Read more about the risks of carotid endarterectomy.
