Carotid Endarterectomy

The build-up of plaque in an individual's carotid arteries dramatically increases his or her risk of suffering a stroke. To remove plaque from these arteries, surgeons often perform a procedure known as a carotid endarterectomy. Dr. Brajesh Lal, a vascular surgeon at the University of Maryland Medical Center, answers some commonly asked questions about carotid endarterectomy below.

How does the carotid artery become blocked?

The carotid artery is responsible for supplying blood to the brain. Blockages in the carotid artery are the result of fatty deposits called plaque within the artery. While most of these plaques remain asymptomatic, some may break, causing a small particle to dislodge, travel up an individual's bloodstream and into his or her brain. This can block off a small branch within the brain and eventually result in a stroke.

What are the risk factors associated with the build up of plaque in the carotid arteries?

Several risk factors associated with the build up of plaque in the carotid arteries include:

  • Age (if an individual is over 50 years old)
  • High cholesterol
  • Smoking
  • Diabetes
  • Gender (if an individual happens to be a male)

This does not mean that individuals outside of these categories are not at risk, but the group that meets these criteria is at a much higher risk of developing blockages in the artery than the average person.

What should individuals with these risk factors do?

Individuals who are concerned that they may be at risk for developing blockages in their carotid artery should discuss with their physician the possibility of being screened to look for blockages in their carotid artery.

What is a carotid endarterectomy?

A carotid endarterectomy is one method of preventing a stroke in individuals who happen to have a carotid plaque. It is a relatively straightforward procedure that was first performed in 1953 and has since been perfected through multiple improvements in surgical technique and technology and other improvements in anesthetic care.

How is this procedure performed?

Most of these procedures are performed under general anesthesia; however, they can be performed under local anesthesia, too. The procedure involves having a vascular surgeon make a very small incision, anywhere from 2-3 inches long, on the front and side of your neck to expose the artery. Once the artery has been exposed, the surgeon will place a little shunt that will continue to provide blood flow to the brain while he or she opens up the artery and removes the plaque. Once the plaque has been removed, the surgeon places small patch before closing the artery to widen the artery and re-established blood flow to the brain.

Are there any risks associated with this procedure?

There is a very small risk, usually to the amount of three or four percent, of developing a stroke because a little piece of the plaque may dislodge while the procedure is being performed. However, most of these strokes are small and do not last very long.

What can patients expect during the recovery process?

Most patients stay in the hospital overnight and are discharged the next morning. Patients can anticipate returning to work and other normal activities within 2-3 weeks after the procedure. Because the incision is small, it heals very well and leaves only a very small scar that is usually imperceptible to others.

Why should patients come to the UMMC to have this procedure performed?

First, let me say that the key components of a successful carotid endarterectomy involve good pre-operative diagnosis and work-up, good operative technique, and good peri-operative care, and I believe that coming to the University of Maryland, you get all three components of good care that make for a good carotid endarterectomy.

At UMMC, our vascular lab is one of the largest in the country and has a tremendous amount of expertise in diagnosing vascular disease, specifically carotid vascular disease. As a vascular surgeon, I have specific expertise in carotid endarterectomy and have been closely involved with all the major advances in the management of carotid disease since its inception. I've been performing carotid endarterectomies for the past decade with very good results and have a large group of very satisfied patients.

I also think the second component -- good peri-operative care -- is equally important. One complication that patients can anticipate with carotid surgery is stress on the heart, and that is why peri-operative care is so important. The University of Maryland Medical Center, partly because of its shock trauma experience, has a phenomenal anesthesia care unit and a phenomenal surgical critical care unit that provide extremely good care to all patients.


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