Stroke Risk Post-Carotid Surgery: What You Need To Know

Carotid artery surgery is a procedure to treat carotid artery disease, which is a narrowing of the carotid arteries caused by a buildup of plaque that can lead to a stroke. The surgery helps restore blood flow to the brain by removing plaque from the carotid arteries. While the surgery can effectively reduce the risk of stroke, it is not recommended for everyone with carotid artery disease due to associated risks.

So, can you still have a stroke after carotid artery surgery? The answer is yes, there is a small risk of having a stroke after undergoing carotid artery surgery. A 2021 randomized trial found that 1% of participants experienced a disabling stroke or died within 30 days of surgery, while 2% experienced a non-disabling stroke.

It is important to note that the risk of stroke and death after carotid artery surgery is relatively low, and the surgery can significantly reduce the chances of more severe conditions and complications. However, as with any medical procedure, it is essential to discuss the risks and benefits with a medical professional to make an informed decision.

What is carotid artery surgery?

Carotid artery surgery is a procedure to treat carotid artery disease. The carotid artery is responsible for bringing oxygen-rich blood to the brain and face. There are two common carotid arteries, one on each side of the neck, that each divide into internal and external carotid arteries.

Carotid artery disease is a condition where a waxy substance called plaques builds up inside the carotid arteries. This build-up can cause the arteries to become narrowed or blocked, reducing blood flow to the brain and increasing the risk of a stroke.

The two main procedures to treat carotid artery disease are carotid endarterectomy (CEA) and carotid artery angioplasty and stenting. During a carotid endarterectomy, the surgeon makes a cut in the neck to reach the blocked carotid artery. They then remove the plaque build-up and stitch the artery back together, restoring normal blood flow to the brain. This procedure is usually carried out under local anaesthesia, but general anaesthesia can also be used.

Carotid artery angioplasty and stenting is a procedure where a thin tube with a deflated balloon on the end is threaded through a blood vessel in the neck to the blocked carotid artery. The balloon is then inflated to push the plaque outward, and a stent is placed in the artery to support the inner artery wall and prevent future blockage.

What are the risks of carotid artery surgery?

Carotid artery surgery is a procedure to treat carotid artery disease. It involves removing plaque buildup from the carotid arteries to restore proper blood flow to the brain and prevent strokes. However, as with any surgery, there are associated risks and potential complications. Here are some of the risks and complications that may occur:

• Anesthesia-related risks: Adverse reactions to anesthesia can include allergic reactions and problems with breathing.
• Bleeding: Bleeding during or after the surgery can be a serious complication and may require re-operation to remove clots.
• Restenosis: The treated artery may become narrowed again over time, reducing blood flow.
• Hyperperfusion syndrome: Increased blood flow in the artery can lead to symptoms such as swelling or bleeding in the brain.
• Blood clots: There is a risk of blood clots forming in the carotid arteries, which can lead to stroke.
• Nerve problems: Nerve damage during the surgery can affect functions related to the eyes, nose, tongue, or ears.
• Cardiac issues: The surgery may cause irregular heartbeats or impact cardiac functions, especially in patients with pre-existing heart conditions.
• Infection: As with any surgical procedure, there is a risk of infection at the incision site or in the treated area.
• Airway obstruction: Swelling or bleeding in the neck can block the airway, requiring immediate medical attention.
• Repeat blockage: In some cases, the carotid artery may become blocked again, requiring further treatment.
• Age and health factors: Older patients and those with underlying health conditions, such as diabetes or coronary artery disease, may have increased risks of complications.

How do you prepare for carotid artery surgery?

Preparing for carotid artery surgery involves several steps to ensure the procedure goes smoothly and that the patient is in good health. Here is a detailed guide on how to prepare for carotid artery surgery:

• Consult with your healthcare provider: Your surgeon or healthcare provider will explain the carotid endarterectomy (CEA) procedure to you, and you can ask any questions you may have. It is important to understand the risks and benefits of the surgery.
• Provide medical history: Inform your healthcare provider about your complete medical history, including any allergies or sensitivities to medicines, iodine, latex, tape, contrast dye, or anesthesia. Disclose all prescription medications, over-the-counter drugs, and herbal supplements you are currently taking.
• Address bleeding disorders and blood-thinning medications: Discuss with your surgeon if you have a history of bleeding disorders or if you are taking blood-thinning medications, aspirin, or other drugs that affect blood clotting. You may be advised to stop taking certain medications before the procedure.
• Disclose pregnancy or potential pregnancy: Inform your healthcare provider if you are pregnant or suspect you might be pregnant, as this is an important consideration for surgery.
• Stop smoking: If you smoke, it is crucial to stop as soon as possible before the procedure. Smoking increases the risk of blood clots and can impact your recovery. Quitting smoking can improve your overall health and speed up your recovery process.
• Follow pre-surgery instructions: Adhere to any instructions provided by your healthcare team regarding fasting or not eating and drinking before the surgery. These instructions are essential for your safety during anesthesia.
• Blood tests: Your healthcare provider may request a blood test to determine how long it takes your blood to clot. This information is crucial for the surgery and your post-operative care.
• Relaxation and anxiety management: You may be given a sedative before the procedure to help you relax. If you have a pacemaker, be sure to inform your healthcare provider.
• Pre-operative assessment: Your healthcare provider will review your health history and conduct a physical examination to ensure you are in good health before the procedure. They may also perform blood tests or other diagnostic tests as part of this assessment.
• Consent form: You will be asked to sign a consent form that gives your permission for the procedure to be carried out. Read the form carefully, ask questions if anything is unclear, and ensure you understand the risks and benefits.
• Dietary adjustments: Your healthcare provider may recommend dietary changes to lower your cholesterol and improve your overall health before the surgery. This may include a heart-healthy diet that is low in fat and cholesterol, focusing on fruits, vegetables, whole grains, lean meats, and low-fat or non-fat dairy products.
• Stop taking blood-thinning medications (2 weeks before surgery): Consult with your surgeon about when to stop taking blood-thinning medications, such as aspirin, ibuprofen, clopidogrel, or naproxen. These drugs can increase the risk of bleeding during surgery.
• Report any illnesses: Inform your surgeon about any recent illnesses, such as a cold, flu, fever, or herpes breakout, before the surgery.
• Follow instructions on the day of surgery: On the day of your surgery, follow the instructions provided by your healthcare team. Take any prescribed medications as instructed and arrive at the hospital on time.

By following these steps and working closely with your healthcare provider, you can effectively prepare for carotid artery surgery and improve your overall readiness for the procedure.

How is carotid artery surgery performed?

Carotid artery surgery is a procedure to treat carotid artery disease. The carotid artery supplies blood to the brain and face. A blockage in this artery can cause a transient ischemic attack (TIA) or stroke. Carotid artery surgery is done to restore proper blood flow to the brain.

There are two procedures to treat a carotid artery that has plaque buildup in it: carotid endarterectomy (CEA) and angioplasty with stent placement. During a carotid endarterectomy, a surgeon will remove the plaque that builds up inside the carotid artery. The patient will receive either general or local anaesthesia. Under general anaesthesia, the patient will be asleep and pain-free. Local anaesthesia will only numb the part of the body being worked on so that the patient does not feel pain. The patient will also be given medicine to help them relax.

The patient will lie on their back on an operating table with their head turned to one side. The surgeon will then make an incision on the patient's neck over the affected carotid artery. A flexible tube (catheter) is put into the artery, and blood flows through the catheter around the blocked area during surgery. The surgeon will then open the carotid artery and remove the plaque inside. After the plaque is removed, the artery is closed with stitches or a patch from the patient's veins or synthetic material. The surgery takes about 1-2 hours.

If both carotid arteries need to be unblocked, two separate procedures will be carried out. The patient's neck will be cleaned with antiseptic to prevent bacteria from entering the wound, and the area may be shaved. The surgeon will then decide whether to use a temporary shunt to maintain adequate blood flow to the brain. A shunt is a small plastic tube that diverts blood around the section of the carotid artery being operated on. Once the surgeon has accessed the carotid artery, they will clamp it to stop blood flow and make an opening across the length of the narrowing. If a shunt is used, it will be inserted at this point. The surgeon will then remove the inner lining of the narrowed section of the artery, along with any fatty deposits (plaque) that have built up. Once the narrowing has been removed, the opening in the artery will be closed with stitches or a patch. The surgeon will check for bleeding and close the incision in the neck after any bleeding has stopped. A small tube (drain) may be left in the wound to drain any blood that might build up after the operation. This is usually removed the following day.

What is the recovery process like?

Recovery after carotid artery surgery

The recovery process after carotid artery surgery is gradual and depends on the type of surgery and anaesthesia used, as well as any complications that may arise. Here is what you can expect:

In the Hospital

You will typically stay in the hospital for around 1 to 2 days after carotid artery surgery. During this time, your medical team will monitor you for any complications and provide you with instructions for your recovery. They may advise you to take a few weeks off work and limit physical activity for a few weeks to ensure a safe recovery.

At Home

Once you are discharged from the hospital, follow your medical team's instructions carefully. This may include taking prescribed medications, such as pain relievers, and controlling your blood pressure and cholesterol levels. Keep the incision area clean and dry, and follow any specific bathing instructions provided by your healthcare provider. You may need to take a few weeks off work and avoid driving until your doctor approves.

Follow-up Care

It is important to attend all your follow-up appointments to ensure your recovery is on track. Your healthcare provider may schedule duplex ultrasound procedures to monitor the carotid arteries in your neck. They may also recommend a healthy diet that is low in fat and cholesterol and advise you to start exercising to prevent future plaque buildup.

Potential Complications

As with any surgery, there are risks and potential complications associated with carotid artery surgery. These include future artery blockage, stroke, nerve damage, bleeding, and irregular heartbeat. Contact your doctor immediately if you experience any unusual symptoms or signs of complications.

Frequently asked questions