Carotidendarterectomy

Carotid endarterectomy is a surgical procedureto unblock a carotid artery. The carotid arteriesare themainblood vessels thatsupply the head and neck.

Carotidendarterectomies arecarried out whenone or both carotid arteries become narrowedbecause ofa build-up of fatty deposits (plaque).This is known as carotid artery disease or carotid artery stenosis.

If a narrowed carotid artery is left untreated,blood flow to the brainmay be affected. This is usually because a blood clot forms anda piece breaks off and goes to the brain. This can result ineither:

• a Heat exhaustion and heatstroke a serious medical condition that cancause brain damage or death
• a transient ischaemic attack (TIA) sometimes known asa "mini-stroke", a TIA is similar to a stroke but the signs and symptoms are temporary and usually disappear within 24 hours

Each year around 110,000 people have a stroke in the UK andaround a quarterof these are caused by a narrowing of the carotid arteries. More than 5,000 carotidendarterectomy procedures were performed on the NHS between 2011 and 2012.

Carotid endarterectomy can significantly reduce the risk of a stroke in people with severely narrowed carotid arteries.In people who have previously had a stroke or a TIA, their risk of having another stroke or TIA within the next three years is reduced by a third after surgery.

It's now thought the operation should be performed as soon as possible after symptoms appear. It's important to seek immediate medical advice if you experience symptoms such as:

• numbness or weakness in the face, arm or leg
• speech problems
• loss of vision in one eye

The advantage of local anaesthetic isit allows thesurgeon to monitor brain function while you're awake. However, there's no evidence that either is safer or better.

During the procedure, a 7-10cm (2.5-4 inch) cut will be made between the corner of your jaw and your breastbone. A smallcut is then made along the narrowed section of artery, and the fatty deposits that have built up are removed.

The artery is then closed with stitches or a patch and your skinis also closed with stitches.

However, there's a small risk of more serious complications, which can include stroke or death in around 3% of cases. Nevertheless, this risk is much lower than in people with carotid artery disease who haven't chosen to have the operation.

Instead, a thin flexible tube isguided to the carotid artery through a small cut in the groin.A mesh cylinder (stent) is then placedinto the narrowed section of artery towidenit andallow blood to flow through it more easily.

Carotid stenting is currently thought to be associated with a higher risk of stroke during the procedure, especially if it's performed in the first few days after symptoms appear. However, it's a useful alternative for people who may be at a higher risk of complications from an operation.

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