Carotid endarterectomy, also known as carotid artery surgery, is the surgical removal of plaque or blockage from the left or right internal carotid artery which supplies a large portion of blood flow to the brain. These blockages are composed of multiple ingredients including cholesterol and calcium and are the same type of blockage that can occur in coronary arteries in the heart leading to angina and heart attacks. Many people with coronary artery disease are found to have carotid artery stenosis (partial blockage) and vice-versa.
As the plaque size increases, the area for blood flow in the carotid artery decreases. This blockage of blood flow, along with a greater risk that a particle of the plaque can break off and travel into the brain, can increase to the point that preventive surgery may be advisable. Stroke is a permanent injury to a portion of the brain and carotid artery disease is one of the common causes of strokes.
Carotid stenosis can be screened by a non-invasive ultrasound test and confirmed with CT or MR scans. Surgery, when appropriate, requires a hospital stay but, in the majority of cases, this can be as brief as 24 hours for patients admitted electively for the procedure. The surgery involves a relatively small incision on the side of the neck and the recovery is usually fairly brief relative to other major cardiovascular surgical procedures. Surgery shortly after a major stroke is not advised and cannot undo the damage caused by a stroke. This is why preventive surgery should be considered for individuals at high risk, including those with greater than 70% blockage, history of TIA, non-catastrophic stroke, and family history of stroke, among other indications.
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