Each side of the neck has an artery called the common carotid. Each common carotid splits into two branches, the internal branch which brings oxygen-rich blood to the brain, and the external branch, which brings blood to the face.

Blockage of the internal carotid artery can reduce blood supply to the brain, causing a stroke. Blockage of the external carotid artery usually causes no problems.

When the internal carotid arteries become blocked by fat and cholesterol build-up as a result of atherosclerosis, the patient may experience symptoms, such as blurred vision, slurred speech, or weakness (all signs of stroke). By removing the fat and cholesterol build-up inside the artery, adequate blood flow is restored and strokes can be prevented.

Most surgeons use general anesthetics (patient is unconscious and painfree). An incision is made in the neck over the blocked carotid artery. The surgeon opens the carotid artery and removes the fat and cholesterol build-up. The artery is stitched closed with sutures.

There are various techniques surgeons use during surgery to reduce the risk of stroke during the operation. These include shunting (using a plastic tube to re-route blood flow to the brain), EEG monitoring, or even doing the operation under local anesthetic so the patient can talk to the surgeon during the procedure.

The procedure may be used to treat symptoms of carotid artery blockage, such as:

• Weakness of the arm, leg, or face on one side of the body
• Inability to move the arm, leg, or face on one side of the body (paralysis)
• Numbness, tingling, or noticeable change in the sensation of the arm, leg, or face on one side of the body
• Difficulty swallowing
• Loss of all or part of vision (blindness) in one eye
• Slurred speech or inability to speak
• Dizziness (vertigo)
• Confusion, fainting, or coma
• Stroke with complete recovery (TIA)
• Severe blockage without any symptoms at all

Seek urgent medical attention if you experience these symptoms. The symptoms may be permanent, but even if they occur transiently and then get better by themselves (TIA, or transient ischemic attack), they still might be a sign of a serious problem.

Surgery should also be done in asymptomatic patients who have carotid artery blockages which cut off between 75-99% of blood flow through the carotid. Large studies have shown that even in patients with severe blockage and no symptoms at all, the risk of stroke is reduced with surgery.

If the blockage is complete (100%), surgery is not indicated.

X-ray studies using special dyes (carotid angiogram) can show the degree of blockage of the carotid arteries. Other studies that can visualize blockages in the carotid arteries are ultrasound and magnetic resonance angiography (MRA).

The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection

Additional risks of carotid surgery include:

• Blood clots
• Brain damage
• Strokes (1-3% in experienced hands)
• Heart attacks

Patients are usually observed overnight to watch for any signs of bleeding, stroke, or compromised blood flow to the brain. There is a recent trend towards letting patients go home the same day, if the operation is done early and the patient is doing well.

Erratic blood pressure, requiring monitoring in ICU, is relatively common, tends to improve within 24 hours, and should not be a cause for concern. Recovery is rapid in uncomplicated cases, and patients are usually discharged home the day after surgery.