Carotid Endarterectomy

What is a carotid endarterectomy?

A carotid endarterectomy is a surgery to remove plaque (fat and cholesterol buildup) from inside your carotid artery. A carotid artery on each side of your neck supplies blood to your brain, neck and face. You may have an endarterectomy on the left or right side of your neck.

Healthcare providers remove plaque from carotid artery walls so you can get better blood flow to your brain. Plaque can slow down or stop blood flow. If enough blood can’t reach your brain, you can have a stroke.

Carotid endarterectomy is a common carotid artery disease treatment. This helps prevent a stroke, which is the fifth leading cause of death in the U.S.

If you have a stroke, it’s important to get to an emergency room for treatment within three to six hours to get the care you need.

When is a carotid endarterectomy performed?

A surgeon will evaluate you and your medical history and test results. They may recommend a carotid endarterectomy procedure if you:

• Have carotid artery disease (Your provider may have seen in an ultrasound that your carotid artery is at least halfway blocked with plaque buildup)
• Have poor blood flow
• Had a transient ischemic attack (TIA) or a mild stroke due to significant carotid artery disease
• Have severe narrowing or blockage in your carotid artery but haven’t had symptoms

How should I prepare for this procedure?

Before a carotid endarterectomy, you may need to:

• Have tests, like a cerebral angiogram, CT angiography or MR angiography. These provide information about your carotid arteries and your brain.
• Tell your healthcare provider about everything you're taking (including nonprescription drugs, herbs and supplements).
• Stop taking certain medications. Most people will remain on aspirin through the procedure.
• Stop using tobacco products.
• Get specific instructions from your healthcare team to help you prepare for your procedure.

What happens during a carotid endarterectomy?

A surgeon performs this procedure in a hospital. A carotid endarterectomy normally takes about one or two hours.

A healthcare provider will give you general anesthesia (like being asleep) or local anesthesia, which means you’re awake but the area to be operated on is numbed. If you get local anesthesia, you’ll also receive medicine to help you relax.

The surgeon takes these carotid endarterectomy steps:

1. Make a 4-inch cut (incision) in your neck at the site of the blockage.
2. Assess the need to keep blood flow going to that side of the brain. If needed, they’ll insert a tiny tube to temporarily reroute blood flow around the blockage or narrowing and isolate the area during blockage removal.
3. Make an incision along the portion of the artery containing the plaque.
4. Remove the plaque and stitch the opening closed. They’ll typically add a patch of material to widen the artery and prevent narrowing from happening again.
5. Restore blood flow to your brain through its normal path.

In a variation of this, a surgeon flips the carotid artery inside out (eversion) to remove the plaque. This may take less time and avoid the need for a patch.

What are the potential benefits and risks of this procedure?

A carotid artery endarterectomy can help prevent future strokes. Most people tolerate the procedure well. In a study of people over 80 who had this procedure, most were alive five years later. Most of those who didn’t live five years died from an unrelated illness.

With an experienced surgeon, there’s minimal risk. But as with any surgery, there’s a risk of complications from a carotid endarterectomy, including:

• Bleeding
• Infection
• Blood clots
• Nerve damage
• Seizures
• Brain damage
• Future artery blockage
• Stroke
• Heart attack

You can consider a carotid endarterectomy a major surgery because of the possibility of life-threatening complications. But the risks vary, depending on:

• The severity of the carotid artery disease
• The location of the blockage
• Whether you’ve had a previous stroke
• The presence of other medical conditions, like heart disease, diabetes or kidney disease
• Your age (older people are at a higher risk)
• Your sex (women may have a higher risk of complications)

What happens after carotid endarterectomy?

You’ll need to stay overnight in the hospital so your care team can monitor you after the surgery. You’ll probably be able to eat and drink several hours after surgery.

You may have a temporary drain in your neck to remove fluid from your cut (incision). This drain will usually only stay in for one day. It’s a common complication to have some neck pain for about two weeks afterward. But you can take standard, over-the-counter pain medications to relieve it.

You may need to start or resume taking aspirin, clopidogrel or other medicines to prevent blood clots.

Your healthcare provider will discuss the results of your procedure with you. For most people, this procedure helps prevent further brain damage and reduces the risk of stroke. But you may need to change some daily habits to prevent plaque buildup, clot formation and other problems in your carotid arteries.

Even with a successful procedure, your healthcare provider might recommend:

• Eating healthier foods
• Being physically active (if it’s safe)
• Not using tobacco products
• Cutting down your stress level
• Taking medicine to lower your cholesterol level

These steps can help keep plaque from building up again.

What is the recovery time?

Carotid endarterectomy recovery is rapid. Most people go home the day after the procedure. After you get home, it’s OK to shower. Just don’t scrub the surgical glue on the cut or let the stream of water hit it.

Check your incision daily and avoid putting any lotions on it. Avoid wearing clothes that rub against your incision.

You can go back to most of your normal activities (like working) in one or two weeks. You can drive after your incision heals and it doesn’t feel uncomfortable to turn your head. Before you fully recover, the area near your jawline and earlobe may feel numb for six months to a year.

Follow-up appointments

Your provider will want to see you one month after your carotid endarterectomy surgery. After that, you should have follow-up visits every six months for two years and then once a year. They’ll want to make sure your carotid artery doesn’t get narrow again. They’ll use ultrasound to check for this in both carotid arteries (even the one where you didn’t have a procedure).

The success rate of carotid endarterectomy is high. People usually don’t have narrowing in the same artery again.

You can expect to have a carotid endarterectomy scar about 4 inches long on your neck. It will likely be less noticeable in a few months.

When should I call my healthcare provider?

Contact your healthcare provider if you have:

• Chills or fever
• Blood or yellow or green mucus when you cough
• Trouble swallowing
• Chest pain
• Swollen legs
• Difficulty being able to see
• Dizziness, weakness or numbness
• Shortness of breath
• Redness on your incision or green or yellow discharge coming out of it
• A headache, confusion or difficulty speaking or understanding others’ words

What’s the difference between carotid endarterectomy and a stent?

A carotid endarterectomy removes plaque buildup from your carotid artery. A stent (mesh tube) keeps your carotid artery open. A provider puts in a stent after an angioplasty procedure that pushes plaque against your carotid artery walls. All of these improve blood flow in your carotid artery.