If treating your blockages in the carotid arteries requires that you undergo a surgical procedure, called a carotid endarterectomy, to remove plaque, your cardiologist will refer you to a vascular surgeon. A vascular surgeon has served a five-year residency in general surgery and has had two additional years of training in vascular surgery.
Before, during, and after your procedure, your surgeon will be assisted by other care team members, including:
An anesthesiologist. An anesthesiologist is a medical doctor trained to administer the drugs that will take you “under” and block any feeling of pain or unpleasant sensation. Your anesthesiologist is involved in your care before, during and after surgery. He or she may do a medical evaluation before your surgery to determine an anesthesia plan tailored for you. During surgery, the anesthesiologist oversees life support and pain control. And after the surgery, he or she also provides life support, including intensive care management if needed. If time allows before surgery, you should discuss the anesthetic plan, as well as alternatives, risks, and benefits of the chosen anesthetic techniques with the anesthesiologist.
Surgery nurse practitioners. Nurse practitioners with experience or special training in caring for bypass surgery patients are important members of the surgery team. With training as registered nurses and graduate- level education in diagnostic and health assessment skills, nurse practitioners may provide basic medical care under physician supervision.
Surgery physician assistants. A physician assistant who is part of your surgery care team may handle some of the steps and perform some of the procedures that a doctor performs, such as taking your medical history, placing catheters and tubes, doing daily rounds and providing patient education for self-care after you leave the hospital. Physician assistants working in the surgery suite also may serve as a “first assistant” to the surgeon. In addition to having received a broad medical education to become a physician assistant, many return after graduation for advanced education in medical specialties, such as cardiothoracic surgery.
Operating room nurses and technicians. Operating room nurses and technicians support the cardiac surgeon as he or she performs the procedure. They also monitor your condition and work to make you as comfortable as possible.
An intensivist. An intensivist (or ICU doctor) is a medical doctor who specializes in the care of critically ill patients, usually in an intensive care unit (ICU). An intensivist may be trained in internal medicine, anesthesiology or another medical specialty. In addition, the ICU doctor will have completed a fellowship of one or more years’ duration in critical care medicine. Depending on your hospital, you may be under the care of an intensivist while in the ICU or the cardiac surgery ICU.
Intensive care nurses. If you are moved into the hospital’s intensive care unit, you will be cared for by intensive care (or critical care) nurses. These nurses have special training in caring for patients facing life-threatening problems, including cardiac and respiratory emergencies.
Cardiac care nurses. Cardiac care nurses are specially trained to work with heart disease patients and their families. They may have an additional specialty – that of critical care nurse – that prepares them to work with patients in the hospital. You may be visited by a cardiac care nurse in your home following carotid endarterectomy.
Physical therapists/occupational therapists/rehab nurses. Both while you are in the hospital and after you are discharged, these medical professionals work with you to help you build your strength, restore function and regain your ability to move.
Rehabilitation team. A team of health care professionals, including nurses, exercise physiologists, physical therapists, occupational therapists, dieticians and nutritionists, counselors and others, will provide education and coaching to speed your rehabilitation. During rehab, the team will support you as you learn and adopt heart-healthy behaviors, such as eating a healthy diet, exercising regularly, and managing stress.
Your cardiologist or neurologist continues to be closely involved with your case while you are under the care of the vascular surgeon. He or she, in turn, should also provide reports and updates to your primary care physician in order to ensure coordination of your care.