1.What is carotid endarterectomy? It is a treatment to surgically remove or replace the diseased part of the carotid artery 2. Why do you need surgery? Every day, many people around the world suffer a stroke or develop the danger signs of a stroke (mini-stroke or transient ischemic attack). These people are at high risk of having another stroke in the future, and possibly a major cerebral infarction or fatal stroke. For these patients at high risk of stroke, appropriate medication is needed to reduce the risk of stroke, including smoking cessation, control of blood glucose, blood pressure, lipids and treatment of heart disease, in addition to long-term oral aspirin. However, patients with carotid artery stenosis beyond a certain level should receive surgery. The carotid artery is located in the neck and supplies blood flow to the brain. Atherosclerosis can cause narrowing of the blood vessels, resulting in decreased blood flow. Currently, to our knowledge, patients with carotid stenosis are significantly more likely to have a stroke than those without stenosis. Moreover, performing carotid endarterectomy (removal of stenosis) can significantly reduce the risk of stroke and death. 3. Pre-operative preparation: You may be invited to be hospitalized within a few days before the surgery. After admission, our supervising physician and nurse will introduce you to the ward and precautions. Blood tests and routine examinations will be performed 1 to 2 weeks before surgery. The day before surgery, your attending physician and anesthesiologist will explain to you the specific details about the surgery and anesthesia, and you can ask any questions you may have, after which you will be asked to sign an informed consent form. You will be asked to sign an informed consent form. You will not be allowed to eat after 00:00 the day before surgery and you will not be allowed to drink two hours before surgery. If you cannot sleep that night due to nervousness, you can ask the doctor on duty to prescribe you a sleeping pill to ensure sufficient sleep before surgery. 4.Procedure: Carotid endarterectomy in hospital is usually performed under local anesthesia (carotid plexus anesthesia), but it can also be performed under general anesthesia. After successful anesthesia, an incision will be made in your neck to expose the carotid artery so that it can be blocked and opened. Once the carotid artery is exposed, a plastic tube (carotid diverter) will be inserted at both ends of the blocked carotid artery to ensure blood flow to the brain while stripping the sclerotic plaque. Once the sclerotic plaque is stripped, the arterial wall is sutured and the diverter tube is withdrawn, usually using a special polyester patch to close the carotid artery in order to avoid future restenosis. Finally, the skin is sutured and a drainage tube is placed in the wound before suturing to facilitate drainage of the residual blood around the artery. 5.Postoperative instructions: After you are awake from the anesthesia, we will take you back to your room and give you fluids and medication to keep your blood pressure stable. You can drink water and eat a small amount of liquid food 1~2 hours after the operation. There is usually only mild pain after the procedure, but you can ask for pain medication if the pain is unbearable. You may feel discomfort in your throat. You may try to get out of bed the day after the surgery. If there are no special circumstances, we will not give you intravenous fluids. You can have your wound stitches removed 5~7 days after the surgery, and you can be discharged from the hospital after the stitches are removed. 6.What are the risks of surgery? A small amount of wound oozing and skin petechiae is normal and will usually subside in a few weeks after surgery. The procedure rarely requires blood transfusion unless there is a lot of bleeding during the operation. You may experience numbness in the neck, occipital area, or around the ear on the side of the surgery. This sensation usually decreases or subsides within a few months after surgery, but may sometimes last longer. You may experience transient weakness in half of your mouth or tongue, but this is usually rare and mostly temporary. You may also have cardiac and pulmonary disease after surgery, but this is mostly seen in patients who have smoked before. Intraoperative cerebral infarction and death are rare, occurring in less than 4 percent of cases. However, the surgery will prevent you from having a major cerebral infarction in the future. The surgeon will explain the above-mentioned risks to you in detail before surgery. 7. Are there other alternative treatments? You may have been treated with various levels of medication, but unfortunately these treatments are far less effective than surgery in reducing the risk of cerebral infarction. In recent years, a new treatment method, carotid intervention, has been widely used in clinical practice. Specifically, a balloon is introduced into the carotid artery through a guidewire under X-ray guidance, and the stenotic segment is balloon dilated and a stent is placed to solve the carotid stenosis. However, the long-term success rate of this treatment method is not yet clear. 8.What should I do after discharge from the hospital? You will usually receive a follow-up letter from us some time after the procedure. Please come to the follow-up appointment at the designated time if possible to review the patency of the carotid artery after the procedure. The procedure usually has a good long-term patency rate, but you should also take care to prevent the progression of atherosclerosis with regular exercise, smoking cessation, blood pressure and blood sugar control, a low-salt, low-fat diet, and aspirin. The above measures will also help prevent atherosclerosis in other blood vessels. Patients with bilateral carotid stenosis should not undergo bilateral carotid endarterectomy at the same time, and the two procedures should be performed at intervals.