Carotid Artery Disease

The carotid arteries supply blood flow to the brain. Plaque buildup in these arteries is known as Carotid Artery Disease (CAD), or Carotid Stenosis. This condition puts a person at risk for stroke.

If you have one or more of the following risk factors a physician might want to order a carotid ultrasound:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Obesity
  • Smoking and other tobacco use
  • A family history of early heart disease
  • Lack of exercise
  • An unhealthy diet
  • If you have suffered a stroke or mini-stroke
  • If your doctor hears a bruit (high pitched sound) on the side of your neck with a stethoscope

How Carotid Artery Disease Causes Stroke

CAD causes more than half of the strokes in the United States. Typically, this occurs because a fragment of plaque or a blood clot forming on the plaque surface breaks loose, travels downstream, and blocks small arteries in the brain. Learn more about symptoms of stroke.

Treating severe carotid stenosis reduces the risk of stroke. Treatment also helps prevent a recurrence in stroke survivors. The gold standard treatment for CAD is a surgical procedure known as carotid endarterectomy. This operation has been performed for more than 70 years and has a proven track record of long-term success in reducing the risk of stroke.

Carotid Endarterectomy

Performed under a light general anesthetic, carotid endarterectomy typically takes one to two hours. You will have a breathing tube during the procedure. The carotid artery is not far from the surface of the skin. The surgeon makes a small (5-7 cm) incision along the side of the neck, shifting neck muscle aside to expose the artery. After temporarily clamping the artery, the surgeon makes a longitudinal cut into the artery wall. Plaque is removed by scraping the inner lining of the artery with a small spatula. Sometimes a temporary shunt will be used to divert blood flow to the brain around the part of the artery being scraped. Once the plaque has been removed, the surgeon closes the artery by sewing a small patch into its open edges, thus enlarging the artery. The patch decreases the chance of recurrent narrowing to less than five percent over the course of a lifetime.

Patients typically stay overnight in the hospital and are discharged the following morning. Sometimes, blood pressure medications are withheld or temporarily adjusted after surgery because it is not atypical for the blood pressure to be temporarily lower than usual after carotid surgery. It is common to have a sore throat or hoarseness for a few days after surgery, because of the breathing tube.

Restrictions and recommendations for the first two weeks following surgery include:

  • Keeping your head elevated at nighttime on two to three pillows
  • No driving, swimming, or heavy lifting

It is common to have numbness around the incision after surgery, which will decrease over time. Risks of this procedure include heart and lung issues, nerve injury (less than one percent), stroke or mini-stroke (one to three percent nationally). Bleeding issues and infection are rare (less than five percent).