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Treatment for Carotid Artery Disease: Carotid Endarterectomy and Stenting (7572)

Treatment for Carotid Artery Disease: Carotid Endarterectomy and Stenting (7572) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, PVS

7572





Treatment for Carotid Artery Disease:
Carotid Endarterectomy and Stenting

There are 4 arteries in your neck. They
supply blood to your brain. They are the
right and left internal carotid arteries and the
right and left vertebral arteries (see picture).
The internal carotids supply most of the
blood flow to the brain.
These arteries can become narrowed due to
plaque buildup. This can block the blood
flow to your brain. You may then be at risk
for stroke.









Symptoms of blocked carotid
arteries
ξ Trouble speaking
ξ Trouble walking
ξ Loss of control of an arm
or leg
ξ Trouble understanding
what you hear or read
ξ Loss of balance

If these symptoms come and go,
you have had a Transient Ischemic Attack
(TIA) or a mini-stroke. If the symptoms
don’t go away, you’ve had a stroke. You
should always call your doctor if you have
any of these symptoms. It could lead to a
stroke if you are not treated. The buildup of
plaque in arteries is called atherosclerosis.

Risk Factors for atherosclerosis:
ξ Age
ξ High blood pressure
ξ Diabetes
ξ Smoking
ξ High cholesterol
ξ Obesity
ξ Lack of exercise
ξ Family history
ξ Irregular heartbeat, especially atrial
fibrillation (a heart condition where
the heart chambers quiver and beat
ineffectively)

Some of these risk factors cannot be
changed (age, family history, etc.). But
there are some things you can do to reduce
your risk:
ξ Stop smoking
ξ Start an exercise routine
ξ Get better control of hypertension,
diabetes, and high blood cholesterol
ξ Lose weight
ξ Reduce stress
ξ Change your diet



Tests
You may have a number of tests before your
doctor will decide the best treatment for
your narrowed arteries. These may include:
ξ Carotid Duplex Scan: Doppler
ultrasound is used to measure the
blood flow in your carotid arteries.
ξ CT scan (computerized tomography):
A scan of your head and neck that
creates an image of your arteries and
brain.
ξ Angiogram: A series of x-ray
pictures are taken using contrast (x-
ray dye). It can pinpoint a blockage
in your arteries.
ξ Magnetic Resonance Angiogram
(MRA): an imaging technique that
uses a strong magnet, radio signal,
and a computer to produce pictures
of the blood flow from your arteries.
ξ Magnetic Resonance Imaging (MRI):
the same type of test except it
produces pictures of your brain.

Treatment
The treatment will depend on the extent of
your disease, where the narrowed arteries are
located and how severe your symptoms are.
The main concern is to prevent a stroke
because the side effects may be permanent.
Treatment options may be medical or
surgical. Medical treatment includes anti-
platelet medicines, statin drugs that lower
your cholesterol, blood pressure medicines





and other lifestyle changes listed above (see
Risk Factors). Surgical treatment includes
carotid endarterectomy and stent placement.

A carotid endarterectomy is surgery to
remove the blockage in the blood vessels
leading to your brain. An incision is made
in the neck and the plaque is removed. The
surgery takes about 2 hours.

Stent placement is an artificial device being
placed in your artery. This helps keep the
artery open and improve blood flow to the
brain. It is inserted into a groin artery using
guided x-ray until it reaches the narrowed
artery. When it is in place the balloon is
inflated, pushing the plaque against the
artery wall. A metal stent is placed to keep
the artery open.



Surgery Risks
There are risks with every surgery. It
depends on your overall health and how
severe your disease is. Your doctor will
discuss your risks with you before you
decide on a treatment option. Some risks
include:
ξ Neck bruising, swelling and
discolored skin if you have
endarterectomy
ξ Groin bruising, swelling and
discolored skin if you have a stent
placed
ξ Damage to nerves in neck. This can
result in a hoarse voice, numbness,
or trouble swallowing. These
symptoms often do not last.
(endarterectomy only)
ξ Reaction to contrast dye
ξ Sore throat
ξ Blockage can reform over time.
ξ Rarely, a stroke can occur.

Care of the Incision
Most carotid endarterectomy incisions are
closed under the skin so there are no sutures
on the outside. You may shower, but do not
soak in the bath. You may allow the water
to flow gently over the area. Do not rub the
incision. After your shower, gently pat dry.
When shaving, be careful to avoid the
incision.

Numbness
It is normal to have some numbness along
your incision, neck, and earlobe. This
numbness may decrease with time.

Pain Control
It is normal to have some pain at the incision
and in your neck. Your doctor has
prescribed medicine for you to use at home.
This is often the same type you have been
getting in the hospital. As time passes, the
pain will decrease. Then you may use
acetaminophen (Tylenol ) or ibuprofen
(Advil ) if you have not had other problems
with these medicines.

Activity
By the time you go home, you may be doing
some of your normal routine. You may tire
more easily than before surgery. This is
normal. Your strength and energy level will
increase as your body heals.

You should sleep with your head raised on at
least 2 pillows. This will help decrease the
swelling in your neck.




What to Avoid
ξ No lifting more than 10 pounds for 2
weeks.
ξ Avoid contact sports or heavy
exercise.
ξ Your new scar will require sunscreen
for the rest of your life. Start using
sunscreen after 4 weeks. Protect
your scar with a scarf or clothing
before that time.
ξ Ask your doctor at your follow-up
visit when you may return to work.
Also ask when you can resume
sexual activity.
ξ If you had a carotid endarterectomy,
do not drive until advised by your
doctor. It may be hard to turn your
head due to neck pain. Do not drive
after taking narcotic pain
medicine.
ξ If you had a stent placed, you may
drive when you no longer have pain
in the groin for at least 3 days. Do
not drive after taking narcotic
pain medicine.

Diet
You may resume your normal diet when you
return home. Drink plenty of liquids (8-10 8
oz. glasses of water per day) and eat foods
high in fiber (whole grain breads and
cereals, fresh fruits and vegetables). This
will prevent constipation and straining to
have a bowel movement. If this does not
help, use a stool softener (such as Colace®)
or a laxative.

Follow Up
You will be scheduled for a clinic visit a
week or two after surgery. You will need
continued exams of your carotid arteries
with a carotid duplex scan. The first scan is
usually scheduled for 3 months after your
procedure.

When to Call 911
The symptoms below can be life-
threatening. If you notice them, call 911 and
go to the nearest emergency room right
away even if they last only a few seconds or
minutes. These are warning signs of a stroke
and early treatment is vital.
ξ Sudden severe headache with no
known cause.
ξ Unexplained dizziness, unsteadiness,
or a fall.
ξ Sudden dimmed or lost vision,
especially in one eye.
ξ Trouble speaking or trouble
understanding speech.
ξ Sudden weakness or numbness of the
face, arm, or leg on one side of the
body.

When to Call your Doctor
Twice each day you should look at your
incision. Watch for signs of infection. If
you notice any of theses signs or symptoms,
please call your doctor.
ξ An increase in redness or warmth at
the area of the incision.
ξ Red streaks on your skin coming
from the wound.
ξ A bulging or swelling at the incision.
ξ Any new drainage or bleeding.
ξ If your incision opens.
ξ Fever greater than 100.5 θ F (38.1 θC)
by mouth. If it is still more than
100.5 θ F after 4 hours, call your
doctor.
ξ Pain or numbness that worsens or
numbness in a new area.
ξ Problems with constipation.

Phone Numbers
If you have more questions once you are
home, please call the Vascular Surgery Clinic
from 8:00 to 5:00 pm at (608) 263-8915.






After hours, nights, weekends, and holidays,
this number will give you the paging
operator. Ask for the PVS doctor on call.
The doctor will call you back.
If you live out of the area, call 1-800-323-
8942.

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Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©10/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7572