Carotid endarterectomy is an operation to clear the blockages from inside an artery. It is well-established and is the main procedure used. To make sure that you are well enough to have this operation you will have some

Additional Tests.

These will probably include:
• blood tests
• a breathing test
• an electrocardiogram, to check your heart rhythm
• an echocardiogram (an ultrasound test of your heart to check it is working properly).

If you smoke you will be advised to stop smoking as soon as possible before the operation. Smoking reduces the amount
of oxygen in your blood and can increase your risk of breathing problems during the procedure. Stopping altogether is best, but cutting down will also help.

Ideally, surgery should be carried out within two weeks of your symptoms of stroke or TIA although at present, the average time it takes to receive an operation is around three weeks.

Carotid endarterectomy may be carried out under local or general anaesthetic in an operation that takes one to two hours. If both of your carotid arteries need surgery, this is usually done in two separate operations. A urinary catheter may be used to drain urine from your bladder.

You will also need an IV drip to make sure you get enough fluids during and after surgery and your blood pressure will be carefully monitored.

The surgeon will make a small incision (cut) in the side of your neck so they can see your carotid artery, which will then be clamped shut. If need be, a small piece of tubing will be used to re-route blood flow along another artery – this is to make sure your brain still gets enough blood.

The surgeon will then open up your artery and remove the inner lining along with any debris. It is likely that a graft will then be sewn onto your artery to widen it – most surgeons believe this lowers the risk of a repeat stroke. A graft is a piece of tissue that may be taken from a vein in your thigh, or it may be man-made.

When the surgeon is ready, your artery will be stitched up, the blood supply restored, and the small cut in your neck sewn up.

Although this sounds like a very dramatic operation, most people recover remarkably quickly. Within a few hours you can usually sit up in bed, and are able to go home in a couple of days.

The wound in your neck should heal to a fine scar after a few months. You may be advised to limit your physical activity for a short period. Most people can return to work after four to eight weeks but extra care needs to be taken in jobs that involve manual labour.

Where possible, light duties should be performed until you fully recover. You will be able to return to driving two to three weeks following your operation, providing that you can perform an emergency stop safely and look over your shoulder.
If you have had a stroke you may have some long-term effects that make returning to work or driving more difficult. Your doctor will be able to advise you further.

What are the risks?
For most people there will be no complications, but as with any operation, there are some risks associated with carotid
endarterectomy.
There is a five per cent risk of having a stroke during surgery. The risk of this happening is usually due to a small blood clot, or other debris, breaking free during the operation and travelling to your brain.

Therefore, carotid endarterectomy is only recommended if you have severe stenosis, where the risk of having another stroke without the operation is greater than the risk associated with the procedure.
There is also a risk of death affecting just one per cent of people.

Complications are more likely if you have had a recent, serious stroke, if you have a blockage in your other carotid artery, if you have other health conditions (such as heart disease), if you are an older adult, and if you’re a smoker. Other complications can include:

• wound infection
• bleeding from the site of your wound
• nerve injury, which affects around eight per cent of people and is usually temporary. This can cause a hoarse voice, weakness, or numbness on one side of your face (these symptoms usually disappear within a month)
• numbness or slight pain around your wound (this is normal and will go away with time)
• chest infection – which may require antibiotics

G Mohan.