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Carotid Artery Endarterectomy (CAE)

Last updated March 3, 2019

Approved by: Krish Tangella MD, MBA, FCAP

National Heart Lung and Blood Insitute (NIH)

Carotid Artery Endarterectomy is a surgical procedure that involves removal of the plaque that causes obstruction and subsequent hardening and narrowing of the carotid artery. This illustration shows the process of carotid endarterectomy. Figure A shows a carotid artery that has plaque buildup. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows how the carotid artery is cut and the plaque removed. Figure C shows the artery stitched up and normal blood flow restored. The inset image shows a cross-section of the artery with plaque removed and normal blood flow restored.

Background Information:

What are the other Names for the Procedure?

  • CAE (Carotid Artery Endarterectomy)

What is Carotid Artery Endarterectomy surgical procedure?

Carotid Artery Endarterectomy is a surgical procedure that involves removal of the plaque that causes obstruction and subsequent hardening and narrowing of the carotid artery. The carotid artery is a major artery that provides blood to the head and neck.

What part of the Body does the Procedure involve?

Carotid Artery Endarterectomy procedure involves the carotid artery and the neck.

Why is the Carotid Artery Endarterectomy surgical procedure Performed?

There could be various reasons for performing a Carotid Artery Endarterectomy surgical procedure. Some of them are as follows:

  • Severely blocked carotid artery
  • Mini-stroke or a transient ischemic attack
  • Prevention of stroke

What are some Alternative Choices for the Procedure?

An alternate choice to the procedure is carotid angioplasty and stenting, which is less invasive.

What are the Recent Advances in the Procedure?

The recent advances in the procedure are the use of endovascular techniques, which are less invasive and have shorter recovery time.

What is the Cost of performing the Carotid Artery Endarterectomy surgical procedure?

The cost of Carotid Artery Endarterectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Carotid Artery Endarterectomy surgery and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/002951.htm (accessed 17th July, 2012)

http://www.nhlbi.nih.gov/health/health-topics/topics/carend/risks.html (accessed 17th July, 2012)

http://www.mayoclinic.com/health/carotid-artery-disease/DS01030/DSECTION=risk-factors (accessed 17th July, 2012)

Prior to Carotid Artery Endarterectomy surgical procedure:

How is the Carotid Artery Endarterectomy surgical procedure Performed?

  • During a Carotid Artery Endarterectomy, the surgeon makes an incision on the neck. Next the skin and the underlying tissues are divided and moved, to isolate the carotid artery
  • Sometimes, an artificial bypass is created in the artery to allow the normal flow of blood to the brain while the surgery is being performed
  • A small incision is made on the artery to remove the blockage and alternatively an artificial graft or a graft from a vein in the leg of the patient, may be used
  • Next, the surgeon removes the artificial bypass after closing the artery
  • Lastly the tissue and skin is repositioned and closed with sutures, before the wound is bandaged

Where is the Procedure Performed?

A Carotid Artery Endarterectomy procedure is performed in a hospital. The patient is admitted, undergoes the procedure and is discharged, as per the instruction of the physician.

Who Performs the Procedure?

The procedure is performed either by a general surgeon, vascular surgeon, cardiovascular surgeon or a neurosurgeon, along with an anesthesiologist.

How long will the Procedure take?

The procedure may take anywhere between 1.5-3 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
  • A physician will request your consent for Carotid Artery Endarterectomy procedure using an Informed Consent Form

What is the Consent Process before the Procedure?

A physician will request your consent for Carotid Artery Endarterectomy procedure using an Informed Consent Form

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Carotid Artery Endarterectomy surgical procedure?

Before a Carotid Artery Endarterectomy procedure, the patient has to undergo certain tests such as:

  • Routine blood and urine analysis
  • ECG
  • Chest X-ray
  • Arteriogram
  • CT Scan of the head and neck
  • The physician may suggest further tests depending on the health of the patient and their medical history. Do note that the patient may have to do all or a few of the above tests.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Carotid Artery Endarterectomy procedure?
  • Why is this procedure necessary? 
  • What does the procedure involve?
  • How will this procedure help?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Carotid Artery Endarterectomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered local anesthesia either with or without sedation. However, in some cases, general anesthesia may be administered. When general anesthesia is necessary, the procedure is usually performed at a hospital surgery facility.

How much Blood will you lose, during the Procedure?

Since the procedure involves making an incision and is invasive there will be some amount of blood loss. This may differ from patient to patient.

What are the possible Risks and Complications during Carotid Artery Endarterectomy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
  • Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders and chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during a Carotid Artery Endarterectomy are as follows:

  • Excessive bleeding
  • Infection
  • Breathing problems
  • Seizure
  • Stroke

What Post-Operative Care is needed at the Healthcare Facility after Carotid Artery Endarterectomy surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Carotid Artery Endarterectomy surgical procedure:

What are the possible Risks and Complications after Carotid Artery Endarterectomy surgical procedure?

Post Carotid Artery Endarterectomy surgery, the following complications may arise:

  • Infection in the surgical wound
  • Heart attack
  • Stroke
  • Hematoma (blood clots around the surgical wound)
  • Brain damage
  • Blockages (in the future)
  • Numbness, observed in the face

What is the Prognosis after the Surgery?

The recovery from the procedure is generally good, and complications are rare.

When do you need to call your Physician?

Do contact your physician/surgeon if you notice any of the following symptoms:

  • Pain around the surgical wound
  • Swelling and redness
  • Bleeding or drainage
  • Visual disturbances
  • Numbness in the face
  • Problems with speech
  • Fever
  • Dizziness
  • Muscle ache
  • Nausea or vomiting
  • Signs of Infection
  • If any new symptom or discomfort is observed

What Post-Operative Care is needed at Home after Carotid Artery Endarterectomy surgical procedure?

At home, the following post-operative care is recommended, after Carotid Artery Endarterectomy procedure:

  • Complete the course of medication
  • Avoid strenuous exercises
  • Wash the wound with mild soap while bathing
  • Resume daily (normal, regular) activities only after you feel better (per physician’s advice)
  • Keep legs elevated while resting
  • Avoid taking non-prescribed medications
  • Avoid sex, unless advised otherwise by the physician

How long does it normally take to fully recover, from the Procedure?

It takes about 2 weeks to recover from the surgery. However, it takes about 3-4 months to completely feel sensation in the neck region, around the surgical wound.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

 The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Carotid Artery Endarterectomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital
  • A general surgeon, vascular surgeon, cardiovascular surgeon or neurosurgeon
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before a Carotid Artery Endarterectomy surgical procedure is performed. 

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 15, 2013
Last updated: March 3, 2019