What can I expect during carotid endarterectomy?

Generally, carotid endarterectomy (CEA) surgery for carotid artery disease follows this process:

1. An intravenous (IV) line will be started in your arm or hand. An additional catheter will be inserted in your wrist to monitor your blood pressure, as well as for obtaining blood samples. One or more additional catheters may be inserted into your neck, opposite the surgery site, to monitor your heart function. Alternate sites for the additional catheter include the subclavian (collarbone) area and the groin.
2. You will be positioned on the operating table, lying on your back, with your head raised slightly and turned away from the side to be operated on.
3. A catheter will be inserted into your bladder to drain urine.
4. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
5. CEA may be performed under local anesthesia. You will be sleepy, but will not feel the area being operated on. You will receive a sedative medication in your IV before the procedure to help you relax.
6. If the CEA is performed under local anesthesia, the physician will provide constant support and keep you comfortable during the procedure.
7. Under local anesthesia, you will receive oxygen through a nasal cannula, a tube that fits in your nose.
8. A CEA may also be performed under general anesthesia (you will be asleep). Once you are sedated, a breathing tube will be inserted through your throat into your lungs. You will be connected to a ventilator, which will breathe for you during the procedure.
9. You will be given a dose of antibiotics through your intravenous (IV) to help prevent infection.
10. The skin over the surgical site will be cleansed with an antiseptic solution.
11. The physician will make an incision (cut) down the side of the neck over the diseased artery. Once the carotid artery is exposed, the physician will make an incision into the artery.
12. The physician may use a device called a shunt to divert blood flow around the surgical area to maintain blood flow to the brain.
13. With the blood flow diverted, the physician will remove the atherosclerotic plaque from the artery.
14. The shunt will be removed and the artery will be closed. The incision in the neck will be sutured together.
15. A drain may be placed in your neck.
16. You may receive blood pressure medication through your IV during and after the procedure to keep your blood pressure within a certain range.

When stroke occurs because of a blockage in a carotid artery, surgery to remove the obstruction reduces the likelihood of a recurrence. This surgical procedure is called carotid endarterectomy.

Carotid endarterectomy is a significant surgical procedure that usually requires one or two days in the hospital. You will probably be given general anesthesia, although under some circumstances, patients receive local anesthesia. The surgeon makes an incision in the neck and opens the blocked carotid artery. After removing the plaque and cleaning out the artery, the surgeon stitches the artery back together and closes the incision.