The carotid arteries are the two main arteries that travel to the brain on either side of the neck. The blood supply to the brain comes primarily from these two arteries. When a carotid artery becomes blocked with atherosclerotic plaque, a vascular surgery procedure called a carotid endarterectomy is performed. Carotid artery surgery has certain risks associated with the procedure.
Stroke
Vascular Web states that the risk of stroke following a carotid endarterectomy is between 1 and 2 percent. The development of a stroke immediately postoperatively is usually due to an embolism. An embolism is a small blood clot or small piece of plaque that breaks away and travels to the small blood vessels in the brain. The plaque or blood clot lodges in the small blood vessel. This blocks the flow of blood to the brain and causes the tissue to die. The effects of the stroke will depend on the area of the brain that is injured. Bleeding from the brain will also cause stroke. Intercerebral bleeding occurs when a patient’s blood pressure is very high and uncontrolled. The pressure causes the small vessels to “blow out” and actively bleed into the brain tissue.
Hematoma
Once the surgery is completed the surgeon will close the wound with sutures and place a large compressive type dressing over the wound. The compression is meant to help stop any small bleeders that could contribute to a wound hematoma. According to the American Heart Association, 5.5 percent of patients undergoing carotid endarterectomy have a hematoma or collection of blood under the surgical site. These are typically small and absorb on their own. Large hematomas that continue to expand after surgery may need to be re-explored in order to stop the bleeding. Expanding hematomas also present the possibility of closing off the airway and can become medical emergencies. If loss of the airway is imminent, opening the wound at the bedside is mandated..
Nerve Damage
The recurrent laryngeal nerve lies in the area where the carotid surgery is performed. This nerve controls the voice box and if injured can cause permanent hoarseness and difficulty swallowing. Also damage to cranial nerves in the area of surgery can produce numbness of the face and tongue. According to Vascular Web, these nerve injuries are usually temporary and will clear in about a month.
