Carotid Endarterectomy for TIA and Stroke
For more information about making the decision to have surgery, see:
What To Expect After Surgery
The surgery often takes about an hour. Recuperation includes spending a short time in the recovery room and may include about 24 hours in the intensive care unit to watch for complications.
The hospital stay usually is 1 to 3 days. And normal activities can be resumed within a week as long as the activities are not physically demanding. There may be some aching in the neck for up to 2 weeks. It is important not to turn your head too often or too quickly during your recovery.
Why It Is Done
Your doctor may suggest that you have this surgery if:
How Well It Works
You are most likely to benefit from surgery if you have had symptoms and if your carotid artery is narrowed by 70% or more. People with less than 50% narrowing do not seem to benefit from surgery.1
Carotid endarterectomy is more effective than treatment with medicine alone in preventing stroke for people who have symptoms that can be attributed to a 70% to 99% blockage of the carotid arteries.2
The major risks associated with carotid endarterectomy are:
What To Think About
Carefully weigh the benefits and risks of surgery, and compare them with the benefits and risks of medicine therapy. The success of medicine therapy will depend on how much narrowing (stenosis) is present in the arteries and the choice of medicine. Risks of surgery depend on your age, your overall health, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.
Tests such as carotid ultrasound, carotid arteriography, CT angiography, or magnetic resonance angiography (MRA) are needed before surgery to evaluate the amount of plaque buildup in the carotid arteries and the flow of blood through the narrowed area. (For more information, see the Exams and Tests section of the topic Stroke.) The blood vessels beyond the hardened area are also evaluated. If those vessels are severely damaged, surgery may not be helpful.
Carotid endarterectomy can be done several months after a stroke or TIA. But people benefit most from the surgery if it is done within 2 weeks of the stroke or TIA. Delaying surgery longer than 2 weeks increases the risk for stroke, because people are more likely to have a stroke in the first few days and weeks after a first stroke or a TIA.
The likelihood of complications from carotid endarterectomy varies, depending on the skill and experience of the surgeon. The American Heart Association Stroke Council recommends that surgery be done by a surgeon who has complications in less than 6% of the endarterectomy surgeries that he or she performs and that the hospital rate of complications be just as low.2
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