Carotid endarterectomy



Definition

Carotid endarterectomy (CEA) is a surgical procedure that is performed to remove deposits of fat, called plaque, from the carotid arteries in the neck. These two main arteries, one on each side of the neck, deliver blood and oxygen to the brain. Plaque builds up in large- and medium-sized arteries as people get older, more in some people than others depending on lifestyle and hereditary factors. This build up is a vascular disease called atherosclerosis, or hardening of the arteries. When this happens in either one or both of the carotid arteries, they can become narrowed, a condition called stenosis. During a carotid endarterectomy, a surgeon removes the fatty deposits to correct the narrowing and to allow blood and oxygen to flow freely to the brain.


Purpose

Carotid endarterectomy is a protective procedure intended to reduce the risk of stroke, a vascular condition also known as a cardiovascular accident (CVA). In studies conducted by the National Institute of Neurological Disorders and Stroke (NINDS), endarterectomy has proven to be especially protective for people who have already had a stroke, and for people who are at high risk for stroke or who have already been diagnosed with significant stenosis (between 50% and 70% blockage).


Demographics

The National Stroke Association reports that twothirds of stroke victims are over age 65. Risk is shown to double with each 10 years over age 55. Men are more at risk than women, although most stroke survivors over age 65 are women, which may be partly because there are more women than men in this age group. African Americans have been shown to be at greater risk for stroke than other racial groups in the United States. Risk is also higher in people who have a family history of stroke as well as people with diabetes, because of the circulatory problems associated with diabetes. People with high blood pressure, also called hypertension, have four to six times the risk of stroke.

Nearly 700,000 strokes occur in the United States each year, with about 150,000 deaths, making stroke the third leading cause of death behind heart disease and cancer. Stroke is also responsible for the high number of disabled adults in the United States; two million stroke survivors have some permanent disability. The annual cost to the country for treating stroke and disabilities caused by stroke is about $40 billion.

In a carotid endarterectomy, the carotid artery is access through an incision in the neck (A). A measurement of the pressure inside the vessel is taken to assess the degree of blockage (B). The carotid is clamped above and below the incision, and a shunt is inserted to maintain blood flow (C). Plaque lining the artery is removed (D). The shunt is taken out (E), and the incisions are repaired (F). (Illustration by GGS Inc.)
In a carotid endarterectomy, the carotid artery is access through an incision in the neck (A). A measurement of the pressure inside the vessel is taken to assess the degree of blockage (B). The carotid is clamped above and below the incision, and a shunt is inserted to maintain blood flow (C). Plaque lining the artery is removed (D). The shunt is taken out (E), and the incisions are repaired (F). (
Illustration by GGS Inc.
)

Description

The presence of fatty deposits in the carotid arteries of the neck is the most significant risk factor for ischemic stroke, which represents 80% of all strokes. A stroke can be either ischemic, which is an interruption of blood flow in a narrowed carotid artery, or hemorrhagic, which involves bleeding in the brain. Carotid endarterectomy is performed as prevention of ischemic strokes.

Some people at high risk for ischemic stroke have disturbing symptoms that can occur periodically and last from minutes to up to 24 hours, and then disappear. These episodes are called transient ischemic attacks (TIA). The symptoms are the same as actual stroke symptoms. The symptoms of TIA and ischemic stroke may include:

About 35% of people who have TIAs will have a stroke within five years. The risk of stroke goes up with age and is greatest in people whose blood pressure is higher than normal. High blood pressure stresses the walls of blood vessels, particularly when the vessels are blocked with plaque and so space for blood to pass is reduced.

Carotid endarterectomy has been performed since the 1950s as a stroke-prevention method. During the 1990s, about 130,000 carotid endarterectomies were performed each year in the United States. Because the surgery itself presents a high risk of complications, surgeons will look at the possible benefits and risks for each patient and compare them with such medical treatment as drug therapy to reduce plaque, cholesterol, and blood pressure. Carotid endarterectomy is typically performed on those who will benefit most from the surgery and who have the lowest risk for postoperative complications. Good candidates include:

Carotid endarterectomy is not recommended for:

The endarterectomy procedure takes about an hour to perform. General anesthesia is usually administered. A vascular surgeon or neurosurgeon will usually perform the surgery. During the procedure, a small incision is made in the neck below the jaw to expose the carotid artery. Blood that normally flows through the artery must be diverted in order to perform the surgery. This is accomplished by rerouting the blood through a tube (shunt) connecting the vessels below and above the surgical site. The carotid artery is opened and the waxy fat deposit is removed, sometimes in one piece. If the carotid artery is observed to be too narrow or too damaged to perform the critical job of delivering blood to the brain, a graft using a vein from the patient's leg may be created and stitched (grafted) onto the artery to enlarge or repair it. The shunt is then removed, and incisions in the blood vessels, the carotid artery, and the skin are closed.


Diagnosis/Preparation

Diagnosis

The presence and degree of stenosis in the carotid artery must be determined before a doctor decides that carotid endarterectomy is necessary. Carotid stenosis can sometimes be detected in a routine checkup, especially when a detailed history reveals to the doctor that the patient has experienced symptoms of TIA or stroke. The doctor will use a stethoscope to listen to blood flow in the carotid artery and may hear an abnormal rushing sound called a "bruit" (pronounced "brew-ee") that will indicate narrowing in the artery. The absence of sound, however, does not mean there is no risk. More extensive testing will most likely have to be done to determine the degree of stenosis and the potential of risk for the patient. These tests may include:

Preparation

If carotid ultrasonography or arteriography procedures were not performed earlier to diagnose carotid stenosis, these tests will be performed before surgery to evaluate the amount of plaque and the extent and location of narrowing in the patient's carotid arteries. Other blood vessels in the body are also evaluated. If other arteries show significant signs of artherosclerosis or damage, the patient's risk for surgery may be too great, and the procedure will not be performed. Aspirin therapy or other clot-prevention medication may be prescribed before surgery. Any underlying medical condition such as high blood pressure or heart disease will be treated prior to carotid endarterectomy to help achieve the best result from the surgery. Upon admission to the hospital , routine blood and urine tests will be performed.

Aftercare

A person who has had carotid endarterectomy will be monitored in a hospital recovery room immediately after the surgery and will then go to an intensive care unit at least overnight to be observed for any sign of complications. The total hospital stay may be two to three days. When the patient returns home, activities can be resumed gradually, as long as they are not strenuous. During recuperation, the patient's neck may ache slightly. The doctor may recommend against turning the head often or too quickly during recovery. The most important thing people can do after endarterectomy is to follow their doctor's guidelines for stroke prevention, which will reduce the progression of artherosclerosis and avoid repeat narrowing of the carotid artery. Repeat stenosis (restenosis) has been shown to occur frequently in people who do not make the necessary changes in lifestyle such as in diet, exercise , and quitting smoking or excessive use of alcohol. The benefits of the surgery may only be temporary if underlying disease such as artherosclerosis high blood pressure, or diabetes, is not also treated.


Risks

Serious risks are associated with carotid endarterectomy. They involve complications that can arise during or following the surgery, as well as underlying conditions that led to blockage of the patient's arteries in the first place. Stroke is the most serious postoperative risk. If it occurs within 12 to 24 hours after surgery, the cause is usually an embolism, which is a clot or tissue from the endarterectomy site. Other major complications that can occur are:

The risks of carotid endarterectomy surgery depend upon age, overall health, and the skill and experience levels of the surgeons treating the patient. The likelihood of complications is lower when the surgeon performing the procedure has acknowledged skills and experience. According to the Stroke Council of the American Heart Association, surgery is best performed by a surgeon who has only had complications occur in less than 3% of patients. Hospitals, too, should be able to show that fewer than 3% of their patients undergoing endarterectomy have had complications. These recommendations are based not only on skill levels, but also on the ability to accurately weigh the stroke risks for each patient against the potential risk of complication because of age, hereditary factors, and the presence of underlying conditions or diseases.


Normal results

The desired outcome of carotid endarterectomy is improved blood flow to the brain and a reduced risk of stroke. The National Stroke Association has reported that successful carotid endarterectomy surgery reduces risk of stroke by as much as 80% in people who have had either transient ischemic attacks or symptoms of stroke, or who have been diagnosed with 70% or more arterial blockage. Studies of people who have no symptoms but have been found to have stenosis from 60% to 99%, show that endarterectomy surgery also reduces the risk of stroke by more than 50%. These groups of people at higher risk for stroke will benefit most from having carotid endarterectomy. The benefit for people who have lesser degrees of blockage is shown to be much lower than that of high-risk stroke candidates. Surgery is not indicated for people with artery narrowing less than 50%.

Morbidity and mortality rates

Death and disabling stroke occur more often in symptomatic and asymptomatic patients at high risk for stroke who have not been treated with carotid endarterectomy surgery. A well-respected study, the North American Symptomatic Carotid Endarterectomy Trial (NASCET), along with a corresponding European study (ECST), showed that death or disabling stroke are reduced by 48% among those with severe stenosis (greater than 70%) when they undergo carotid endarterectomy surgery. In patients with less severe stenosis (50–69%), endarterectomy was shown to reduce risk by 27%. Patients with less than 50% stenosis were actually harmed by surgery, increasing the risk of death or disability by 20%. The conclusion of the study was that death and disability could be reduced overall if carotid endarterectomy was performed only on patients with the more severe stenosis who are also surgically fit, and that that the procedure should be performed only by surgeons whose complication rates are less than 6%.


Alternatives

The carotid endarterectomy removes plaque directly from blocked arteries and there is no alternative way to mechanically remove plaque. However, there are alternative ways to prevent the buildup of plaque and thus help to prevent stroke or heart attack. Certain vitamin deficiencies in older people are known to promote high levels of homocysteine, an amino acid that contributes to atherosclerosis, putting people at greater risk for stroke or heart attack. Certain nutritional supplements have been shown to reduce homocysteine levels.

Nutritional supplements and alternative therapies that are sometimes recommended to help reduce risks and promote good vascular health include:

Resources

books

Caplan, L. R. American Heart Association Family Guide to Stroke Treatment, Recovery, and Prevention. New York: Times Books, 1994.

Moore, R. D. The High Blood Pressure Solution: A Scientifically Proven Program for Preventing Strokes and Heart Disease, 2nd Edition. Portland, OR: Inner Traditions, 2001.


periodicals

Harrar, S. "Brain Attack." Prevention Magazine 20 September 2002.


organizations

National Institute of Neurological Disorders and Stroke (NINDS). National Institutes of Health, Bethesda, MD 20892. http://www.ninds.nih.gov .

National Stroke Association. 9707 E. Easter Lane, Englewood, CO 80112. (800) Strokes or (303) 649-9299. http://www.stroke.org .


other

Carotid Endarterectomy: Questions and Answers. Harvard Medical School and Aetna. http://www.intelihealth.com .

Carotid Endarterectomy: What to Think About. Healthwise, Inc., Boise, ID. http://www.laurushealth.com/newsearch .

Uncontrollable Stroke Risk Factors and Controllable Stroke Risk Factors. National Stroke Association, Stroke Prevention Guidelines. http://www.stroke.org .


L. Lee Culvert

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Carotid endarterectomy is performed in a hospital or medical center operating room by a vascular surgeon or neurosurgeon.

QUESTIONS TO ASK THE DOCTOR




Also read article about Carotid Endarterectomy from Wikipedia

User Contributions:

1
Yoshihiko Nomi
It is mentioned that ultrasound imaging with Doppler is used for diagnosis; do you use any surgery type probes during the procedure for monitoring purpose or aftercare.

Thank you,

Best regards,

Y. Nomi
2
Barbara Clark
Good article on surgery and selecting surgeon/hospital
3
CW
I felt this article was extremely helpful to me and my family. Thank you so much.
4
cecilia
I'm a first semester Nursing Student and we have to do all the patho behind our patient's diagnoses. This article gave me all I was looking for!!! Thank you so much!!! The article was flowing great in details and explanations! This is so helpful!!
5
V.Allen
My father is 74. He had a carotid Endarterectomy about three weeks ago. Six days after the surgery he started to experience total weakness and use of his legs. As a result, he was hospitalized for a week for test -- Nothing could be found to cause this trouble. He must now get around in a wheel chair. I would appreciate any advice or possible cause. He had the surgery at Pitt Memorial Hospital in NC. He is scheduled for another follow up on 1 Oct 08.

Sincerely,
V. Allen
6
John G
What about carotid stents? I have heard that in the hands of skilled interventionalist these are a reasonable alternative to patients with higher surgical risk?
7
anita
My father is 57. He had a carotid Endarterectomy about 1 month ago. he also got 2 stroke after fourth day of surgery doctor hospitalized him for fifteen days more now he is ok now but he started to experience total weakness and use of his body parts his BP is still fluctuating upto 180 although walking and doing daily work. I dont know the cause, I would appreciate any advice or possible cause.
Excellent format and through coverage to ease a patient and loved ones' anxiety.
Thank you.
My husband is 62 and had a carotid Endarterectomy his voice is funny not able to clear his throat and when could he start driving and working again
Good info I am going to send this to my mom who is having this surgery soon and this has been very informational
Hey T.G.I.F,
I guess this is the best info I can get {and give} on the surgery.
Andrea
My sister is going to have the carotid endarterectomy surgery one day next week,So she wanted me to look it up and tell her what it is really and how it is done,cause when doctors come in and start talking you really dont know what they are saying , So thanks the informations it was very helpful
Hello, My name is Wayne my father age 70 just past Tuesday (10-13-10) had a carotid arterie operation on the left side of neck. It was 75% blockage and the other was 95% blockage. The 75% the doctor said it needed to be work on before the 95% because it was block in more than one spot. He went through the operation great but he can not get the blood pressure to keep normal. He is a heavy smoker and a take shot diabete. The surgerant past he to his reg doctor and dad is not doing good. His blood pressure spikes up to 225 at time and hard to get it down taking some kind of pills to bring it down but sometimes it take about 20 minutes to start comming down. He has been going late at night to the hospital to get it down. He is still fighting the high blood pressure... My question is HOW LONG WILL HE HAVE TO FIGHT THIS HIGH BLOOD PRESSURE. The doctor said that the brain has to read the flow and pressure before a normal pressure. The heart been use to work harder to push the blood. He feels fine but blood pressure is not working for him.. Thanks Wayne
I am a candidate for this procedure. I have one additional problem. The Doppler and CAT scans indicate 100% blockage in the left carotid artery and 60 % in the right. It is the right one that will be addressed. I had some vision problems in my right eye and this led my doctors to this point. We have known about the left total occlusion for several years. I had a triple by-pass operation in 1984 without any problems. Scans of that operation showed blockage but indicated re-channeling of the blood.
I am 78 yoa and in relatively good health. I think that the above history places me at a greater risk than usual. Do you have any suggestions? I'm ready to go do it.
Thank you.
Sam Litzenberg
am i at greater risk for complications during surgery on my right artery(85% blocked) since my left artery is completely closed. which procedure
would be less risky?
Need help please. We live in Peu and muy husband of 65 has been diagnosed with carotid obstruction the left 85% and the right one 95%. We visited several doctors who recomend surgery and we are very scared about the risks
My question is exists any therapy to reduce the problem not necesarily surgery?
One day in this december 2010 he felt dizzy and his left hand dormed so we went to emergency
and after exams we knew about the corotids.
He has no colesterol and his blood presure in controled with medicine and he has no other problems. Please any specialized doctor who reads this , let me know what to do.
I´ll be waiting and thanks a lot.
Niky
17
Kathy
We recently learned that my husband (age 71) has 99% blockage on left carotid. He had open heart surgery for valve replacement and double by pass 3 1/2 years ago. He will have the carotid Endarterectomy surgery in the next couple of weeks. We apprecite all the information in this article. It 100% backs up what the surgeon told us last week. Of course, our goal is to prolong a healthy life and reduce as much as possible his stroke risk. There were no indications of problems--just a routine physical exam due to a switch in our primary care physician. We feel fortunate and are optomistic. The comments of post surgery issues have me a bit concerned... I thought we'd be okay after the first 24 hours. I'll be watchful.
After seeing you New Years we knew this was a possibility. Same as what my Dad had and they went well. Wayne, you are a tough and your attitude for life is your best armour. You know that our thoughts and prayers will be with you. As you say, just a little bump in the road.

You have to get well soon being as we are going to Mexico in the Spring. And YES, I have my passport stuff all ready to submit.

Love you guys

Mary Kaye and Nick
my husband just had this surgery 6 days ago. his blood pressure has been a little high, but today it dropped significantly. when should i become concerned enough to take him to the er?
Was preparing for both knee replacements, and they found an 80% stenosis on the right side. Had surgery Tues, Jan 18th, came home next day. Dr. said I was doing great. I was ready for my own bed. I do have a little swelling which Dr. told me I would have. I have a great heart doctor, who recommended the Vascular Dr. in Wichita. I would recommend both to any one that needs great doctors. Now, surgery for knees is scheduled for Feb. 7th. I'm ready to get on with my life. Thanks for the informative document on Endarterectomy.
hi nice informative article to know about Carotid endarterectomy (CEA) surgical procedure
22
vicki vanbrunt
My husband had the operation Jan 19th. Left side of neck, he is having a problem everytime he eats & chews. He has pain in the jaw & side of neck, I made him eggs & toast and the bread was hard for him even chichen cut up small. I don't remember this problem 6 years ago when he had the surgery on right side. We told the doctor & he said eat slow & it might take awhile yet. This time they had to put in a pigs artery I believe. He had no problems last time, but I was wondering if this is normal to hurt even if it is soft bread.
just had the surgery two days ago, feeling pretty good.very tired,and some soreness okon surgery side{right side}ok so far
I am a 2nd year Operating Department Practice (ODP) student. This article has useful information and has helped me in my case study.Thank you.
I had carotid artery surgery 3 years ago on the left artery. Sometimes I get pain over the incision site. Is this a problem.

Carmen
26
Debbie
Very informative article, it answered the questions and more that I was searching for. Thank You
27
Fred Jachem
11-18-2011;
Just had a carotid endarterectomy (CEA) surgical procedure done on my right side 5 days ago which had about an 80-90% blockage. Stayed in the ICU for two days until they could get my blood pressure stabilized. Heart rate and BP was running low after surgery. My cardioligist took me off all my high blood pressure medications and I'm being monitored to see when and if my BP gets back to around 150/ so he can start me on probably some new types of BP medications.
Staples should be removed in about 10 more days and hopefully I'll be back to work around that time.
my sister has been diagnosed with this problem, she actually has two places in the side of her neck that are blocked. before this dx, she ad a stroke in her eye that was on same side as blockage, she has been heavy smoker for 40 years plus high cholesterol runs in family. dr told her that her chances are better if she has the surgery, instead of leaving it alone, since she already had the eye stroke, she has lost most of her vision in that eye also. she is being operated on by a surgeon thru the VA in Little Rock, Ar, i hope this dr has the same degree of experience as non military doctors. I am really concerned for her. thanks so much for this article, it rings true with everything her doctor told her, which makes me feel better.
29
Stacie
Thank you! I am a STSR Student and this article has greatly helped me with my case study for this term :O)
30
jean
MY HUSBAND IS 75 AND HAS A 90 PERCENT BLOCK ON THE RIGHT SIDE OF NECK AND 30 ON THE LEFT. THEY CAN NOT OPERATE BECAUSE IT HAS GONE UP TO FAR. THEY SAY HE HAS HAD A STROKE ON THE RIGHT SIDE BUT THE ONLY THING THAT HAS BOTHERED HIM IS TINGLING IN HIS RIGHT HAND AND
NUMBNESS IN THE RIGHT SIDE OF HIS LIP. COULD YOU TELL ME WHAT IS TO BE EXPECTED ??
31
c larson
had endarterectomy 4 weeks ago, my jaw is still numb and now I am having pain by my collar bone and around to myshoulder blade. Is this normal?? my surgeon said to come back 3 months post op should I call him sooner?
32
R TOMLINSON
HI
I HAD A ENDARTERECTOMY 6 WEEKS AGO MY JAW IS STILL NUMB AND NOW I HAVE GOT A VERY BAD PAIN IN MY SHOULDER BLADE AND COLLER BONE ,
IS THIS NORMAL
33
Vicki
Feb. 9, 2012 About 6 months ago I had my knee cap replaced. While I was under I was told I was in distress due to a clogged. When I awoke, I was going to have my carotid taken care of. About 2 weeks later They did the surgery, when I woke from the surgery , I found I had no voice.It' now almost 4 month's later, and I only have a whisper of a voice, and have sinus drainage and coughing and choking. 24/7. Can I hope for any hope for any relief in the futher. The doctor that did the surgery just laughs and tells me to be patient.
34
sandee
How long will it take, after the surgery, to recover? I am planning to move from one State to another?
35
perry
just had carotid doppler, right common carorid -no flow, right internal carotid - no flow, right external carotid -no flow, right carotid bulb - no flow, left side ok, what do I need to expect from MD's and how long would the recovery be for such a procedure? could stenting be options for these types of flow problems? I work out at gym and have been in perfect health for 60 years, have stopped using the protein shakes for body building, really concerned yet not panicking so far, THANKS for your advice.
36
blake
My father had this surgery and when he was brought out of the anesthesia is was discovered that he had had a massive stroke during the operation. He died two days later. His blockage was 70% and he had had a TIA a few weeks prior to surgery. The surgeon told us that the blockage extended farther up the neck than expected and that the artery had to be tied off. My question is WHY did he not know the extent of the blockage before surgery. The article above states that patients with blockage extending far up the neck to areas not easily accessible are NOT good candidates for this operation. I will be investigating to find out if sufficient testing was done to determine the extent of the blockage. This procedure was performed at Kaiser Permanente.
37
robin truskett
I found that having the endarectomy with patch in a leading Sydney hospital 4 weeks ago, with a local anaesthetic, was much more traumatic than having my 2 hip replacements last year. I am 70 years old and a retired registered nurse, so thought I knew what to expect. I still have a very swollen incision, some vocal problems and a numb neck. The only saving grace is that it's better than having a stroke!
38
deb
MY 78 YEAR OLD MOM HAD CARTOID ARTERY SYRGERY ON THE RIGHT SIDE 5 WEEKS AGO. HER VOICE HAS NOT RETURNED. SHE SOUNDS LIKE SHE HAS BRONCHITIS ALL TIME. IS THIS NORMAL OR DO WE NEED TO CONSULT THE SURGERON AGAIN? HE SAID THERE WAS NO CUTS MADE TO CORDS OR BOX
39
Kim A
My father-n-law had this surgery a month ago. His voice, etc is fine. However, he has uncontrollable shakes in his hands now. He wasn't like this before the surgery. What could be causing this?
40
Frank DeBilio
Having had a major stroke in 1997, then had right carotid done. recently had a TIA. The artery had closed up again. recently had left side carotid done. Very informative article.
41
Aidan Coleman
My neighbour Bill here in Dublin Ireland had a carotid endarterectomy right side in March this year.
No history of stroke.
He is worried that since the operation 5 months ago his neck is constantly numb
from the right side of the neck all around the back to the left side neck
and up from under his right ear to the top of his head.
It is very numb on awakening after sleep and reduces somewhat as the day progresses but never goes away.

Your comments and advices will be much appreciated.
42
mick gittoes
how soon can I fly after a carotid endarterectomy. thanks
43
Sunil Mirji
My Dad was underwent Left Carotid Endarectomy 3 years ago and during surgery he met with a massive stroke. His physical disability revived by 75% within 6 months. But his speech, eyesight and cognitive skills got affected. After the endarectomy, the stitches opened up and blood leaked outside the area causing clot which had to be removed separately. It has been 3 years since the surgery and till now he complains about severe neck pain on opearated area. Consulted many surgeons - performed many angiograms - but nothing showed up. Last doctors concluded that his brain is sending false signals about the pain to that area and that is the reason for the pain. Biggest question is - how do we solve this mystery..? We are unable to find the actual reason behind the pain, and if it is psychological then what is the solution to this?? Any experts in this field - i request your advice. Help is greatly appreciated..
44
Deb Stafford
My Mum is having the operation as I type this. Her right side 75% blocked. She had a minor stroke approx 3 months ago. Mum was also told that there was a fairly high risk that she will have a stroke during or shortly after the op. He also advised her that he could guarantee if she did not have this op that she will definitely have a major stroke in the future. I am very scared at the moment for her.
45
andrea
hi, my mum has carotid artery disease and waiting to see a neurologist, i was wondering if anyone knows if she will stop going dizzy and regain from blurred vision an being confused, does anyone know.
46
Junkie N
Just had the carotid endarterectomy 4 weeks ago and this is worst to get over than my heart bypass surgery. Would not recommend to anyone.
4 weeks later and still getting loads of pain and the numbness in my neck and face is so unreal, like I'm been hacked at all the time and having muscular spasms as well.
Love to hear from more people who have recently had same done
47
ELVI
WILL LOST VOICE EVER RETURN.
4 MONTHS SINCE LEFT ENDARTERECTOMRY.
STILL CANT SPEAK ABOVE WHISPER.
RIGHT DONE 15 YEARS AGO WITHOUT AMU PROBLEM.
48
Lars
Had L/side done mar14. Pain in ear and under ear lobe when putting food or drink in my mouth,.L/Jaw is numb and L/face is like sunburn tender. Difficuly to touch or shave.Awaken every morning with earache.L/muscle in upper L/chest and L/neck does not move.Was this caused by a stroke during surgery or damage done to them nerves at the time of the surgery.
49
cam
I had left side done in April 2014. Have neck pain-and head aches. I have 80% blockage in the right sude and will have another doppler. Does this lack of mobility go away.?
50
sue appleyard
had right endarterectomy on 21st june, by teatime my neck feels like a ton weight on right side, find eating takes longer and sharp pains occur anytime, hard areas down scarline and wound started oozing since post day 10, otherwise have to be thankful found problem now as was having various symptons that i was not taking seriously. just hope artery doesnt fur up again for a long time and to keep check on the other side.
51
denise
hi i had left corotid artery op 5 weeks ago im have pain in shoulder blade and collar bone different from right side im unable to lift my arm above waist levelfrom the side has anyone else got theses problems thank you
52
Robert Pavin
My husband had his carotid artery on the left side 8 days ago and he started swelling up a lot today. Very concerned. Should we call 911
53
sarah
i had a Carotid Endarterectomy friday 12/20/13 been doing ok but anyone know how long it takes for the swelling to go down?hurts to eat but drinking ok...
54
julie
I had surgery November 26 on my right side. My neck, face and ear on that side are still numb and problematic. Anyone got an idea how long to expect this? I have a 3 month check next month. Both left and right were over 95% blocked and the left should be done in about a year. This surgery, and I have had several different surgeries in my 58 years was one of the most horrid experiences I have had. I am no wimp. Was in the hospital 6 weeks with multiple trauma after a vehicle accident 12 years ago so have had my share of pain.
55
ron
a lot of negative comments; are there any positive?
56
Sue
My mother had carotid artery surgery 5 months ago. She developed fluid in a lung following the surgery and one month later was hospitalized with pneumonia and a blood infection. She has numbness in her. jaw and neck and her voice is weak and hoarse. She also complains of a feeling of tightness in her throat as well as pain in her neck and shoulders. Can anything be done about the numbness and problem with her voice? She is getting very frustrated.
My Husband had carotid endarterectomy procedure and 5 days later started to bleed out in his neck. They found a surgical sponge was left inside and could have punctured the artery. The insurance is now saying that this could be normal from the surgery. My question is can a hematoba happen 5 days after the coratid endarterectomy?
58
Stan Neumann
TIA @ age 68yrs,57days. Ultrasound w/Doppler showed abnormality; follow-up CTA awaiting surgeon's decision. Reading this article will allow informed conversation w/the surgeon. Thanks, SgN
59
Jeffre Johnston
how long before my body stops getting high bp spikes after carodic artery surgery. it has been 2 1/2 years
since surgery. otherwise I feel fine

Thank you
Jeffrey Johnston
60
Janice Kalter
I had carotid endarterectomy the end of April of this year (2014). My left artery was 99% blocked. My face on left side was swollen and numb and to some extent still is. My lower lip on right side droops. I am seeing a second neurologist this month because the first said lip problem had nothing to do with surgery which is not true as everything was normal before surgery. I'm surprised to find that doctors really don't want to give you much information so I'm asking for my medical records. I had no pain or problems after the surgery as some people have but I want to know if the swelling, numbness and lip issues are transient or permanent.
61
Sherrill Ferrera
I had surgery on my right carotid two years in December. I am experiencing swelling off and on in that area. I had surgery on my left side three years ago and it is finally back to normal. When can I expect this right side to be back to normal? .
62
MARY
Had my left carotid artery done one month ago and my blood pressure is still off the wall. It runs 224/117 every evening. My neck swells and is numb and my eyes water and I feel like there is a fist in my jaw. My jaw is numb. I had a twist and a kink in my left. My cholesterol was perfect and my blood pressure was great before surgery. Can someone tell me who I should see to help with the blood pressure! My surgery seems to not be concerned. He said it will eventually get better, but I am 67 and very active and still work. This is miserable right now. Any advice?
63
kj
I had left carotid endarterectomy 6 weeis ago, I had 80% stenosis & 4 Tiabefore they kept me in for emergency surgery.. 4 week's after, I've had terrible dizzy spells n similar symptoms that I had b4 op! Apparently, it's my imagination, altho my right foot had been agony since.. I get pain over my scar n my neck's still very numb. I have my 6 week check this Friday after another Doppler scan on,Thursday. I hope I get all clear but I am slightly anxious in case op wasn't as successful as 1st thought?
64
Carolyn Bright
i had this surgery one month ago, neck is still sore. main problem is the weakness in legs, no engergy a all. how long will this last? very hard to do anything because of total weakness.
65
Jerry Burshek
HOW LONG DOES IT TAKE TO BUILD UP 80 - 90PER CENT BLOCKAGE IN A CAROTID ARTERY?
66
Kim Wakefield
Mid Jan I had a stroke. Didn't know it at the time. I went to the doctor because I was so sick. He said I had the flu, but had also had a stroke. 57 years old. I didn't have the "usual" symptoms. Both carotids were blocked almost 99%. The doctor said I was a walking dead person and very lucky to be alive. In 17 years he'd never seen anything like it. I had the stroke on the left side but it affected my left side. I'm backwards apparently. I wish I could say the pain lets up. I had the first surgery Mid Feb and the second end of Feb. My surgery sites still hurt constantly, the cold is awful, wearing a seatbelt is very painful. I have to have a shirt with a collar because you can't let the skin touch itself. Everyone is different and given the alternative was death; the surgery was a necessary evil, but the constant pain really is touch. That is as much of an answer is anyone can give. Everyone has a different experience. Some folks never have any problems and others have a rough go.
67
nancy smith
I had carotid surgery 2 yrs ago and am suffering from numbness, and feeling of choking. Is this something I will have to live with or is there something I can do this bothers me quite often. Please advivise
68
CR
I have recently had an endarterectomy on my left side. 2 months ago I had it on the right side. I had a mild stroke on the right side, after tests showed both carotid arteries were severely blocked, atleast 90% it was best to go ahead & get the right side cleaned out first. Recovery from the 1st one was rapid & I couldn't have asked for any better. I'm hoping the same goes for this one as well. I'm 4 days post op from the left side. The only difference this time is that my voice was really hoarse for 3 days & it comes & goes. Also there is more numbness in my neck. My bottom lip drawls in a little when I smile. My doctor said that it's from the retractor & will return to normal in a week or so. There's not alot of stories out there from people that have had these procedures. I know the risks are frightening but I believe the benefits out weigh them. Trust in your surgeon. They will take good care of you. There is still ongoing research on the benefits of this surgery versus stenting but everyone is under different circumstances & you or your doctor can find the best path to take.
Had endarterectomy 6 weeks ago. Upon awakening my was very weak continuing to this day. Also hurts to eat and I am constantly choking and coughing.Also have ear pain.
70
Beth
Husband left carotid artery is almost completely blocked, very narrow, and the blockage goes up into his brain. He suffered several TIA's on the left side before it was diagnosed with a MRI. We have been told there is nothing they can do because it's to thin and too long. They have put him on cholesterol meds., blood pressure meds, and blood thinners. Since all these meds cause more problems, I was wondering if there is anything else we can do for this. Also, does he have a chance at a normal life or is he a ticking time bomb and will soon have a major stroke? We are both scared and no one wants to tell you the truth about our odds with this.
71
ruth
I had the surgery 4 months ago. I had a lot of bleeding my face was swollen and had bleeding all around my neck. I also had my lower lip pulled over with drooling and difficulty eating with loss of taste. I still have a lot of neck and jaw pain with numbness. My lip is still pulled. It has been over 4 months. Will it get any better.
72
Thomas Trainor
I have had carotid operation 10 days ago which was not successful, I now find I have too much saliva in my mouth can you tell me why
Thank you
73
Debra Dillenberg
I had my right side carotid endarterectomy two weeks ago. Was 95% blocked. No prior symtoms except some blurred vision. Was heavy smoker. I am feeling good. Little tightness in neck area. Swelling is almost gone. Voice is still a little hoarse. B/P seems under control. I am 62 and diabetic. I had a great experienced doctor and a great low infection risk hospital. All the best to everyone on here.
After reading all the comments,I feel very lucky. I had the surgery 2 weeks ago.my only complaint is right eye discomfort and blood pressure problem. I am so thankful that's all my problems.May everyone that is having problems get better real soon. God bless.
75
Sue
3 yes. Ago, my husband who was a very active man had a Tia and had an endarterectomy.His bp had been controlled with antihypertensive drugs and be lived a full life, did not smoke for 30 yes or drink. During the surgery, his bp went up to 240\120 and stayed that way for 48hrs. To which it came down to 150\90. After discharge his bp became sporadic. In a.m., it could be 118\74 and in evening was 200\124. Many combinations of drugs were tried but bp remained sporadic. He eventually suffered severe kidney disease and was a candidate for dialysis. He died 3 mos. Ago of pneumonia. He fought the battle well for 3yrs.and never gave up but his !ife was taken after this operation. We have since found out that his surgeon had not had a good record. My husband was his first patient after he located to our area. The hospital quietly did not review his contract. It was a difficult road we traveled and I don't want anyone to live this life, ever. What are your thoughts on this matter. Thank you,for listening and God bless you.
76
Susan Trainor
Endarterectomy 3 months ago. Went well after BP leveled out. I am 61 and have had surgeries, broken bones, regular stuff. This was surprisingly a horrible experience compared to what they prepare you for. Collar bone and shoulder very painful, unable to fully use arm on surgical side. Ear aches constantly. Dry cough mostly, then out of the blue sinus drainage is choking. Tightness in neck, get panicky and claustrophobic while trying to sleep. What can be done. I have a high pain tolerance normally, but this is driving me nuts. Am a nervous wreck.
Had my surgery on July 24, 2015 and all is well with the small exception of loss of feeling in the facial skin and neck skin from nerve damage (considered permanent). A small price to pay for a new lease on life. Multiple bruises with being on Plavex for an unknown time forward.
78
ADemers
My dad just had this surgery 6 weeks ago and he has totally lost his voice. We did not know this could be a complication. His Dr told him at his follow up there was a 50% chance he could get his voice back.He said this is rare that it happens, 5% chance a person looses their voice from this surgery. This is very concerning to us. Anyone else experience this, and did the voice come back, if so how long did it take? My dad is very depressed since his Dr visit and I'm sure this is the reason.
79
lisa
My father had this done a year ago, after the surgery I did not get to speak to the doctor ( I was in the bathroom when he came out of the waiting room) by the time I had figured out my father was out of surgery the doc had left the hospital. recently he had a panoramic x-ray which showed 19 little metal things in his neck, the dentist asked him had he been injured in the war or had he recently had cancer treatments. I looked back in his records & looked at the booklet he was given about the operation said they would close the artery with sutures. Was told these could be clips used in the surgery, we were not told that he would have anything left inside like this, unsuccessful reaching the doc I am hoping someone can direct me where I might find something about this is this normal?
80
dee
I AM 67 years and had carotid endarterectomy done the first of July and now my right has lose of hearing went to ENT and they found out that the Dr that did procedure pinched the tube in ear off and left me with lose of hearing for the rest of my life.
81
Chaitanya agnihotri
My left neck carotid 90 percent nlocked, surgeon suggested disection and replace with my other veins, how safe the operation will be surgeons has done many this is in New Jersey , st michael hospital. Newark. Nj.
I read post operation, nevk pain, speech problem, is it worth it to go through when this problem occurs. Stroke is worst if not done. Please advise. A
82
zvi porath
With 80% blockage at the inner left side and a history of a previous stroke about 10 years ago, when a person takes drugs for high blood pressure cholesterol and diabetes.
a direct question; does this situation calls for an immediate surgery, or it is recommended to treat with aspirin and to wait 6 months?
The atricle gives an insight into the prevention and treatment of stroke. It also help or provide answers to a lot of questions about strokes
84
Tara
Why can't the carotid endarterectomy be performed minimal invasively, so removing it from the inside out in combination with an guiding imaging technique like for example (intravasculair) US? Is this being researched over the past few years?
85
Ann Sexton
Why does my eye droop after carotid endarterectomy? I am very conserned
86
Mary
Informative however i wondering re recovery . Planning to go nursing home for a week . Would this be sufficient . I am getting proceedure on right artery of neck.
87
Roc
I had this surgery and I wish I didn't have to get it my left arm are is weak and numb my voice is horse. The doctor said it could take up to 6 months for my voice to return. My collar bone hurts. This surgery was awful.
I had this operation nearly a year ago. I had mini strokes and my left side was blocked by 78 percent. I was unwell for s year and my doctors told me I was paranoid about strokes. I'm still in a lot off pain. Numb face and neck and get major panick attacks and tKing anti depressants to get through it I'm 48 years young. I'm grateful to my surgeon to be alive. but this is hurrendous. Mentally Nd painfully
89
cathy
i had carotid endarterectomy 7 days ago.i seem to be doing good. when will i be able to go back to work
90
Margaret lyall
I am due to have a blocked artery unblocked. At present I feel sluggish with slight numbness in left arm and leg. Will my condition improve after the procedure?
91
eric
I have carotid endartectomy 6 years ago. I feel choked from scar and nerve damage, It feels like a rop around my neck it doesn't look like its choking me but it is, no one does a thing, I am going to comit suicide eventually, the feel is horrific
92
eric
ps I had heart attack and have asthmafrom smoking 30 years ago so I don't have long anyway but I hate feeling choked if anyone can help please email bedframe10@gmail.com thanks
93
Lou
My husband had an endartectormy last week. He has always had a very low heart beat ranging between 42 - 54. Heart rate has gone up to mid 70's, is there normally and increase in heart rate after this procedure? Bp is a little elevated 160/175 range. His feet that have always been cold are now warm. Would cleaning out the 90% blockage in left artery last week improve heart rate and cold feet?
94
Lou
Just noticed I made error on e-mail address. Anyone who commented on my above post with information as to why heart rate would rise after surgery, remain in 70's when it has been low for years. I would appreciate if you would respond again. Thank You
95
Bev
I also would like to know about heart rate. Had good heart rate (79) before carotid endartterectomy Now my heart rate is 100, 101. Very high blood pressure before surgery which has been better after surgery and at home. Anyone else seeing their heart rate higher after this surgery?
96
Lenny
Has anyone had any good results?? Sounds like alot of complications! Thinking about NO WAY!
97
Joan
PLEASE ARE THERE ANY GOOD CAROTID SURGERIES, I AM SUPPOSE TO HAVE MY RIGHT CAROTID DONE NEXT WEEK BUT I NEVER EXPECTED TO HEAR SO MANY COMPLICATIONS FROM THIS SURGERY.I AM FEELING SCARED. ANY ONE OUT THERE HAVE ANY GOOD THINGS TO SAY IM ALL EARS.
98
Debbie Shrives
My husband has had the op 4 years ago , but is have double vision,and sometimes can only see out 1 eye at a time. What can he do about this. PLS HELP.
99
Buffy
I wanted to post a positive experience here. I had a right carotid endarterectomy in November 2015, at age not quite 65. I had absolutely no complications, and really a nice healing period. I returned to work after 10 days off. My neck and under chin were numb for 6 months as my surgeon had advised me to expect. The feeling gradually came back in my neck over the 6-12 months post-surgery. I still have a small amount of numbness in neck, at the skin level, but not troubling at all. The first scan post surgery at 6 months came back clear. At the time of my surgery I began drinking pomegranate juice (I buy POM) daily -- a small dixie cup (bathroom size) just over half full. Studies have shown this to be effective at keeping the arteries clear, and in fact actually reversing blockage. Good luck to anyone having the surgery. Try and find someone who has done a lot of these surgeries. Question your surgeon about how many he has done, and whether he has had many complications. You can also research your surgeon online to seek out his experience.
100
Irene
I am a fit 80 year old, had my op on the 12th of April (10 days ago) had the stitches removed on Wed, but had to have stereo strips put on wound, as it was a bit open, apart from being very tender over the wound, I'm not to bad, it's just this tingling in my left hand that bugs me, I know the numbness under my chin will go away hopefully in a couple of weeks, it was my left vein that was 90% booked, so I'm thankful to have had it done, better than having a stroke.
I had right carotid endarterectomy six days ago and seem to have a lot of pressure on my whole face, nose, throat, and ears. I have some slight bloody noses and some blood running down my throat. There is some swelling, especially in one area that seems to be a gland. It is swollen like the size of a grape. It seems everyone has different symptoms after surgery and I'm hoping I do not have anything serious. I don't see the Doctor for another week. The instructions were to leave it uncovered and I look like the monster from the Lost Lagoon. I'm all black and blue and the scar is a mess. I don't have any of the serious symptoms of stroke, so I'm hoping for a good outcome, but I didn't think this surgery would be this bad. I had open heart surgery for a valve replacement in the past; I have Lupus and a lot of problems and pain. I'm also a nurse and can take pretty well care of myself. I wish I had found this site before I had the surgery. I would have been more prepared. It has kind of knocked me for a loop.
102
Frank N. Stein
This article was well written and informative. My father underwent this procedure a few weeks ago at age 65 after having 2 TIA events. Immediately after the surgery he lost his voice, but regained it within a few days. He was up and walking around the hospital the day after, and refused all pain medicine, as he did not feel he needed it. He has since returned to a habit of walking several miles each day. The one persistent side effect was some nerve irritation or damage that has caused difficulty moving his tongue, and affects his ability to swallow certain foods. We hope this will improve in time. Each patient is different, but for us, the benefits of the surgery greatly outweigh the eminent risk of stroke.
103
Victoria C Rose
Can the metal clips left in the neck during a carotid endarterectomy be removed years later if they are causing swelling and pain? I had surgery in 2000, and inadvertently, the metal clips to hold the carotid artery in place and to clamp off the blood flow while operating where left inside my neck. Now, all these years later, I have developed much pain and significant swelling around those clips (which I just discovered were left in me). The surgeon I was referred to told me it would life threatening to remove the clips now. Please advise as I am in terrible pain from this.
104
Kathy
SIx and 3/4 yrs ago at the age of 68 I had a cartoid surgery as I was 80% plugged and I was advised I would have a stroke in 5 years. They
used a vein in my right leg above my ankle to cover the left side of my neck as my veins were very small. The operation was very succesful. I
was very tired after the survery after two nights in the hospital but the neck healed quickly but my leg where the vein was removed took three months before I could walk without pain. One surgeon did the neck another surgeon removed the vein all at the same time and fortunately
I did not need a shunt. Good luck to you if you need this surgery.
105
Lucy
I am a 62 year old woman that had a right side endarterectomy that was 70% blocked 10 days ago, and it is still swollen like it was the first day. In other words, I haven't seen any improvement at all and it still hurts the same, if not worse. I am in so much pain, and when I went to the surgeon one week post surgery and asked for pain relief he looked at me like I was crazy. This hurts like hell. Can't move my neck because when I do I get sharp pains in my neck and in my ear. He gave me mild pain pills, but to get relief I have to take three at a time, which means I'm consuming a ton of acetaminophen, over 1000 mgs a pop. None of the pictures online of this surgery look like my neck. The artery is bowed and it looks like they took a 7" straw and shoved it into a 5" space. It's bowed and it sticks out and it looks nothing like any of the photos. I have a lot of numbness and coughing or chewing is very painful. I've had a lot of surgeries in my day, but this is by far, the worse pain of them all. Many thanks to everyone who abuses pain killers, making it hard for those of us who need them, to get them.
106
Charlie
I have read many pertinent questions here, but are there answers anywhere accessible? It's been just over a week since my left carotid surgery (80% blockage). I'm 63 y/o. My surgery was complicated by the carotid artery being discovered as fragile (too thin, kept tearing in the surgeon's hands) so much of it was bypassed with a synthetic graft. Lingering post-op symptoms that concern me is ear-ache pain in left ear, and an acute pain at the back of my skull that is tender and makes sleeping on my back a challenge, So I can only sleep on my right side now until that pain resolves or the incision heals. The left ear is still numb. The entire 7" long incision from the ear to the top of chest bone is numb, hard, and swollen. And I have left shoulder has pain, can't raise left arm past 90 degrees (what position was I in during the surgery? ouch!). I intend to return to work after a 2 recovery period.
107
Suzanne OHearn
I'm 68 yrs old I had the surgery in March 2018 I feel terrible I can"t get out of bed hardly I to wish I never had this done. l kept passing out before operation i was knocked out from a fall for 9 hours & I kept passing out. So went back into hospital for ten days and they found the artery was 88% blocked so i had operation & they sent me home the next day. I have become so weak I can't get out of bed much and all my mussels are weak. I't has been just terrible for me anyways I don't see this working out for me & now wish i just never had it done
108
Wendy
I had my right carotid artery operated on 10 days ago, August 2018. I had suffered a stroke two weeks before, artery was 70% blocked. All went well, touch wood, apart from some discomfort when sleeping. Wake with earache and jaw pain but hope this will improve. Am wondering if those with muscle pain may be having side affects from statins ?? I wish you all best of health and good luck for your future. I had mine done in North Wales and feel very lucky. Hope it all continues without problems.
109
Shawn
I just had carotid endarterectomy surgery 8 days ago. I am 61, was losing vision in my right eye. After seeing eye specialists & electrocardiogram, ultrasound etc. they found a 75 percent blockage. I'm happy I had it done, although getting back to normal has been difficult. I'm still so tired. The hospital called me 3 times a day before surgery & I haven't heard a word from them since. I've never had a procedure where the hospital hasn't given a courtesy call to see how you were doing. I will definitely mention it to my surgeon when I see him again.
110
BARB MCCARTY
I had carotid surgery 3 months ago. I am still suffering from "tightness and pain" which moves around in my rib cage area, down to my groin, into my back, sometimes on both sides. How long does this last? I am very uncomfortable. What is so unusual to me is having this pain move around. Can someone help me?

Comment about this article, ask questions, or add new information about this topic: