Overview

Why is it necessary?

You may need a carotid endarterectomy if you have carotid artery disease.

Carotid artery disease is where 1 or both carotid arteries in your neck is narrowed by a build-up of fatty material (atherosclerosis).

The narrowing of your arteries restricts the blood flow. This increases the chance of a small piece of fatty material breaking off and travelling up to your eye or brain.

If this happens, your risk of having a stroke or transient ischaemic attack (TIA) is also increased. Removing the fatty material lowers this risk.

You may not need a carotid endarterectomy if the narrowing of your arteries is mild. Other treatments, such as medicines to thin your blood and lower your cholesterol, may be recommended.

If you have symptoms of a stroke or symptoms of a TIA and your carotid artery is more than 50% narrowed, you’ll need a carotid endarterectomy as soon as possible.

If you do not have any symptoms but your carotid artery is more than 50% narrowed, you may still need to have a carotid endarterectomy.

If both carotid arteries are narrowed, you may need 2 separate operations a few weeks apart.

Getting Ready

How is it performed?

What happens during a carotid endarterectomy

You'll usually need to go into hospital on the day you have a carotid endarterectomy and stay in overnight.

Do not eat or drink anything before the operation. Your care team will tell you how long you should avoid eating and drinking for.

For the operation, you may be given either a:

• general anaesthetic – meaning you'll be asleep during the operation
• local anaesthetic – meaning you’ll be awake, but your neck will be numb

You’ll be seen by an anaesthetist who will discuss your options with you.

The main steps of the operation are:

1. The surgeon makes a small cut in your neck.
2. Your carotid artery is opened and the fatty deposits (plaques) inside are removed.
3. After the artery is cleared it’s closed with small stitches. The surgeon may also stitch a small patch of man-made (synthetic) material into the artery to help keep it open and stop it narrowing again.
4. The wound is closed with stitches under your skin or stitches or clips that will be removed after a few days.
5. A small plastic drain may be attached to your neck to allow any excess blood to be drained and help reduce swelling.

A carotid endarterectomy usually takes 1 to 2 hours.

Recovery

It usually takes a few weeks to fully recover after having a carotid endarterectomy.

You may have a follow-up appointment with your specialist after your operation to check on your progress and discuss any problems you have.

Recovering in hospital

After the operation, you’ll spend some time in a recovery room before being moved to a ward.

Your blood pressure and pulse will be monitored and the movement in your face, arms and legs will be checked.

If you have any pain or discomfort in your neck, you’ll be given painkillers to take for the first few days.

You should be able to move and walk within a few of hours of the operation. You’ll also be able to eat and drink.

If you have a small plastic drain in your neck, it's usually removed the day after the operation. Your neck may be bruised and swollen, but this will get better after about a week.

You’ll also have a scar several centimetres long on your neck that will usually fade and disappear after a few months.

Recovering at home

Your care team will talk to you about when you can leave hospital. This will usually be the day after the operation.

You may be given medicines, such as aspirin and statins. They will help thin your blood, prevent blood clots and lower your chances of having a stroke. You may need to take statins for the rest of your life.

After having a carotid endarterectomy, there are things you can do to help with your recovery.

Do

• get plenty of rest and return to your normal activities gradually
• start to do some gentle exercise when you feel able to (avoid strenuous activity, such as contact sports, for about 6 weeks)
• speak to your doctor about returning to work – you may be able to go back to work after a few weeks, but it will depend on the type of work you do

Don’t

• do not lift heavy objects for at least 6 weeks after the operation
• do not have a bath or shower until your wound is dry – your care team will give you advice about caring for your wound
• do not smoke as it will make your recovery time longer and increase your chance of having a heart attack or stroke

Driving after a carotid endarterectomy

Do not drive until your neck is free of pain and you’re able to look over your shoulder. It can take around 4 to 6 weeks for your neck to fully recover after the operation.

Your doctor will be able to advise you about whether it’s safe for you to drive.

Risks

It’s rare to have complications after a carotid endarterectomy.

But as with any operation there are risks, including:

• stroke – there's a small risk of having a stroke after the operation
• pain, numbness, bruising or swelling, which usually gets better soon after the operation
• severe bleeding under the wound – this is rare but if it happens you may need further surgery
• an infection in the wound – this is rare and usually easily treated with antibiotics
• nerve damage – sometimes nerves that are close to the carotid artery can be damaged, causing numbness or weakness in your face

The specialist will discuss the risks of having a carotid endarterectomy in more detail with you before you have the operation.

If your carotid artery becomes narrowed again, you may need to have another operation.

Ask for an urgent GP appointment or get help from NHS 111 Wales if:

You’ve recently had a carotid endarterectomy and you have:

• severe pain that does not go away
• pus or blood coming from your wound, or your wound is swollen or tender
• a very high temperature, or you feel hot or cold and shivery

These symptoms could be signs of a problem like an infection.

You can call 111 or get help from 111 Wales online.

Call 999 now if:

• you have weakness or numbness down 1 side of your body
• you have blurred vision or loss of sight in 1 or both eyes
• you are finding it difficult to speak or think of words
• you are confused and have memory loss
• you are feeling dizzy or falling over
• you have a severe headache
• you feel sick (nausea) or you are being sick (vomiting)

These are symptoms of a stroke and need immediate medical attention.

Call 999 to get medical help if you’ve had symptoms of a stroke within the last 24 hours even if they've now stopped.

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring any medicines you take with you.