What is carotid endarterectomy? – is a surgical procedure to remove or replace a diseased part of the carotid artery Why do you need surgery? – Every day, many people around the world have a stroke or show 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) significantly reduces the risk of stroke and death. Pre-operative preparation – You may be invited to be admitted to the hospital for a few days prior to the procedure. Upon admission, our supervising physician and nurse will brief you on the ward and what to expect. 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 stress, you can ask the doctor on duty to prescribe you a sleeping pill to ensure that you get enough sleep before surgery. Procedure – Carotid endarterectomy at our hospital is usually performed under local anesthesia (carotid plexus anesthesia), but 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. Postoperative Instructions – Once you are awake from the anesthesia, you will be taken back to your room and given fluids and medication to keep your blood pressure stable. You will be able to drink water and eat a small amount of fluid 1 to 2 hours after surgery. 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 stitches removed 5-7 days after surgery and you can be discharged afterwards. What are the risks of the surgery? –Small amounts of wound oozing and skin petechiae are normal and usually subside in a few weeks after surgery. The procedure rarely requires blood transfusion unless there is a lot of bleeding during the surgery. 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 can prevent you from having a major cerebral infarction later. Your surgeon will discuss these possible risks with you before surgery. 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 a balloon is dilated and a stent is placed in the stenotic segment to address the carotid stenosis. However, the long-term success rate of this treatment method is not yet clear. What should I do after discharge from the hospital? –Please come to the designated follow-up appointment 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.