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Carotid artery disease is one of the leading causes of stroke in the United States. Medications and lifestyle changes can prevent or reduce plaque in the carotid arteries, but for people with severe narrowing of the carotid arteries, or who have already experienced a stroke or “mini-stroke,” carotid endarterectomy surgery can clear the arteries and restore normal blood flow to the brain.

What Is Carotid Artery Disease?

Carotid artery disease is a condition in which plaque accumulates on the walls of the carotid arteries, the large vessels in the neck that carry blood from the heart to the brain. Plaque is a waxy substance made up of dead cells, cholesterol crystals and fats. As plaque builds up, it causes narrowing or blockage of the carotid arteries, so that the blood flow to the brain is reduced.

Plaque can cause problems in other ways, too. When plaque hardens and cracks, blood clots form at the site of the injury, and these clots can break loose and block blood flow. These clots or broken bits of plaque can also travel into the smaller arteries of the brain and block the flow of blood there. When the blood flow to the brain is interrupted in this way, it causes a stroke or a transient ischemic attack – a brief episode of stroke-like symptoms that resolve within 24 hours.

Carotid artery disease is typically diagnosed by tests such as MRI, CT scan or ultrasound imaging. In some cases, doctors can hear a distinctive sound, called a bruit, caused by blood rushing through the narrowed artery.

Lifestyle factors such as smoking, an unhealthy diet and lack of exercise can contribute to the development of carotid artery disease and other kinds of atherosclerosis, or “hardening of the arteries.” So can health conditions such as diabetes and hypertension. Making healthier choices and managing these conditions can reduce the risk of stroke from carotid artery disease. But in some situations, carotid endarterectomy surgery may be recommended to clear blockages and reduce stroke risk.

What Is Carotid Endarterectomy Surgery?

Carotid endarterectomy surgery is a hospital procedure usually done under general anesthesia. Surgeons cut an incision into a blocked carotid artery and peel away the accumulated layers of plaque on the artery wall to restore the normal flow of blood to the brain. In rare cases, doctors may place a patch made of synthetic material, or a piece of healthy artery from another part of the body, into the artery. After surgery, the incision is stitched.

Patients typically recuperate in a hospital for one or two days, and recover at home for the next two to three weeks. Side effects can include trouble swallowing, a sore throat and numbness in the neck that can linger for weeks or months.

Carotid endarterectomy surgery is a generally safe surgery that has been used since the 1980s to help lower the risks of stroke, but like all surgeries, it isn’t without risks. Possible, yet rare, complications associated with a carotid endarterectomy include an elevated risk of stroke, heart attack or neurological damage.

How Can Carotid Endarterectomy Surgery Help?

Carotid endarterectomy may be recommended for people who have a moderate-to-severe (60 to 99 percent) blockage of the carotid artery, and who have already experienced a stroke or “mini-stroke” in the months before surgery. For these patients, carotid endarterectomy surgery can reduce the risk of another stroke by clearing plaque and opening narrowed arteries to improve blood flow to the brain.

This procedure may also be advised for people who haven’t experienced a stroke or other symptoms of carotid artery disease, but who have a severe blockage (80 percent or more) in the carotid artery. For these patients, the goal is to reduce the possibility of a stroke by eliminating plaque buildup before symptoms appear.

Surgery may not be appropriate for some people with carotid artery disease. For those with less than 60 percent carotid artery blockage, medications such as statin drugs or lifestyle changes that include smoking cessation and a healthy diet can help reduce plaque and improve artery health without surgery. Surgery may also be risky for people with other chronic or severe health conditions such as diabetes or heart disease, or who have severe neurological damage from a previous stroke.

Even though a carotid endarterectomy clears accumulated plaque from a narrowed or blocked artery, the procedure doesn’t prevent plaque from developing again if the factors that contributed to it are not managed. After the procedure, doctors typically advise patients to make healthier lifestyle choices and take appropriate steps to treat conditions such as hypertension and diabetes, which contribute to carotid artery disease.

Over 100,000 carotid endarterectomy surgeries are performed in the United States each year, and the risk of complications such as stroke and heart attack hovers at around 2 to 3 percent. Although this procedure isn’t right for everyone, it can reduce the risk of a stroke or mini-stroke for those with significant blockage of the carotid artery, or those who have severe blockage that increases their risk of a potential stroke over time. If you have carotid artery disease, your doctors and healthcare team can work with you to determine how carotid endarterectomy could help.

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