Carotid artery surgery is a procedure to restore proper blood flow to the brain.

You have an artery on each side of your neck called the carotid artery. This artery brings needed blood to your brain and face.

The blood flow in this artery can become partly or totally blocked by fatty material called plaque. A partial blockage is called carotid artery stenosis (narrowing). Blockage in your carotid artery can reduce the blood supply to your brain. A stroke can occur if your brain does not get enough blood.

• Sometimes the plaque may close off the artery enough to cause a stroke.
• Other times a blood clot may form in the artery, block the narrow part, and stop blood from reaching the brain. This type of clot is called a thrombus. It stays in one place.
• Other times, the clot can travel and get stuck in a smaller blood vessel in the brain. A clot that travels like this is called an embolism.

There are 2 ways to treat a carotid artery that has plaque buildup in it. One is surgery called endarterectomy. The other is a procedure called angioplasty with stent placement.

During carotid endarterectomy:

• You will probably receive general anesthesia. This will make you unconscious and unable to feel pain. Some hospitals may use local anesthesia instead. With local anesthesia, only the part of your body being worked on will be made numb with medicine so that you will not feel pain.
• You will lie on your back on a padded operating table with your head turned to one side. The side that will face up is the side your blocked carotid artery is on.
• Your surgeon will make an incision (a cut) on your neck over your carotid artery. Your surgeon will put a catheter (a flexible tube) in place. Blood will flow through the catheter around the blocked area during surgery.
• Then your surgeon will open your carotid artery. The surgeon will then remove the plaque inside your artery.
• Your artery will be closed up with stitches after the plaque is removed. Blood will now flow through the artery to your brain.
• Your heart and brain activity will be monitored closely during your surgery.

Carotid angioplasty and stenting (CAS) is a less-invasive way to repair the blockage in your carotid artery:

• Your surgeon will make an incision in your groin after using some numbing medicine. You will also be given medicine to relax you.
• Your surgeon will insert a catheter (a flexible tube) through the incision into an artery. The doctor will carefully guide the catheter up to your neck to the blockage in your carotid artery.
• Your surgeon will use live x-ray pictures to see your artery. This kind of x-ray is called fluoroscopy.
• Next your surgeon will pass a guide wire through the catheter to the blockage. Another catheter with a very small balloon on the end will be pushed over the guide wire and into the blockage. Then the balloon will be blown up. The balloon then presses against the inside wall of your artery. This opens the artery and restores proper blood flow to your brain.
• A stent (a wire mesh tube) may also be placed in the blocked area. The stent is inserted at the same time as the balloon catheter. It expands when the balloon is blown up. The stent is left in place to help keep the artery open. The surgeon then removes the balloon.

There are several ways your doctor may know you have narrowing or blockage in your carotid artery. Two common ones are:

• You may have had symptoms of a stroke or a transient ischemic attack (TIA, also called a “mini-stroke”). Some of these symptoms are weakness, blurred vision, confusion, or slurred speech.
• You may not have any symptoms, but your doctor may find a problem during a physical exam. Your doctor may hear something called a bruit when using a stethoscope to listen to your blood flow. A bruit is an abnormal sound in your artery.

Your doctor will need to do one or more tests to see how blocked one or both of your carotid arteries are.

If you have had a stroke, your doctor will consider whether treating your blocked artery is safe for you. Your doctor will compare your risk of having another stroke if you do not have surgery with the risk of having serious problems from the surgery itself. Your doctor must consider:

• How bad the narrowing in your carotid arteries is
• What symptoms you have
• What other medical problems you may have
• Your age

Treatment options your doctor will discuss with you are:

• No treatment, other than checking your carotid artery with tests every year
• Medicine and diet to lower your cholesterol
• Tests to check your carotid artery and blood-thinning medicines to lower your risk of stroke. Some of these medicines are aspirin, clopidogrel (Plavix), and warfarin (Coumadin).
• Surgery to remove the buildup in your carotid artery

Most times, patients who have carotid angioplasty and stenting to treat severe narrowing of their carotid artery have this procedure because carotid endarterectomy would not be safe for them.