A carotid endarterectomy is the surgical removal of plaque (fat and cholesterol buildup) from inside your carotid artery, which supplies blood to your brain and your face. There’s one carotid artery on either side of your neck. Blood flow inside your carotid arteries can slow down or stop when plaque collects in your artery walls. If enough blood can’t reach your brain, you can have a stroke.
If you have a stroke, it’s important to get to an emergency room to get prompt medical treatment within three to six hours.
To see if a carotid endarterectomy is a treatment that makes sense for you, a vascular surgeon will:
You and your healthcare provider will decide whether to proceed with surgical therapy. A vascular surgeon performs this procedure in a hospital surgical suite.
Your healthcare provider may recommend a carotid endarterectomy if you:
If a carotid endarterectomy surgery isn’t the right treatment for you, your provider may want to check your carotid artery once a year. You may need to improve your diet to bring your cholesterol level down and start taking blood thinners like aspirin or clopidogrel to prevent a stroke. Your provider could also perform an angioplasty (which pushes plaque against your carotid artery walls for better blood flow) and put in a stent (mesh tube) to keep your carotid artery open.
Your provider may have seen a lot of plaque buildup in an ultrasound of your carotid artery or you may be having issues with poor blood flow in that area. A carotid endarterectomy clears plaque from your carotid artery so you can get better blood flow to your brain. This helps prevent a stroke, which is the fifth leading cause of death in the U.S.
Carotid endarterectomy is a surgery that’s a carotid artery disease treatment.
Carotid endarterectomy is the most commonly performed surgical treatment for carotid artery disease.
In addition to a physical exam, you may have tests a few days before your procedure to ensure it’s safe to perform the surgery. Your surgeon may order a cerebral angiogram to better define your brain’s anatomy. A cerebral angiogram is an invasive diagnostic test that produces X-ray pictures of the inside of blood vessels in your head.
In many instances now, however, your healthcare provider may get this information from either a CT angiography or MR angiography. These are noninvasive methods to obtain information about your carotid arteries and your brain, and these can be performed without risk of stroke.
You may need to stop taking certain medications before your carotid endarterectomy, so be sure to tell your healthcare provider about everything you're taking (including nonprescription drugs, herbs and supplements). Your healthcare team will give you specific instructions to help you prepare for your procedure. Most people will remain on aspirin through the procedure. It’s important to check with your healthcare provider before stopping aspirin or clopidogrel if you’re on these medications.
You should also stop using tobacco products before your surgery.
A carotid endarterectomy normally takes approximately two hours.
Your healthcare provider will give you general anesthesia (like being asleep) or regional anesthesia, which means you’re awake but the area to be operated on is numbed. If you get regional anesthesia, you’ll also receive medicine to help you relax.
The surgeon takes these carotid endarterectomy steps:
Most people stay overnight in the hospital to watch for problems after their procedure.
You may have a temporary drain in your neck to remove fluid where your provider made an incision. This drain will usually only stay in for one day.
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. However, unless you adopt a healthier lifestyle, plaque buildup, clot formation and other problems in the carotid arteries can return.
A carotid endarterectomy can be highly beneficial in preventing future strokes if you've already had one, possibly cutting your risk by one-third in the three years after surgery. Most people tolerate the procedure well.
Even with a successful procedure, your healthcare provider might recommend:
These steps can help keep plaque from building up again.
As with any surgery, there is a risk of complications, including:
However, with an experienced surgeon, there's minimal risk.
The risks of a carotid endarterectomy vary, depending on:
If your healthcare provider recommends this surgery as a treatment option for you, talk with them about why they recommend the procedure, the benefits and risks, and the hospital's surgical outcomes.
While the operation can result in some neck pain for about two weeks afterward, you can take standard, over-the-counter pain medications to relieve it.
Recovery from a carotid endarterectomy 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 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 in three or four weeks. You can drive after your incision heals and it doesn’t feel uncomfortable to turn your head. The area near your jawline and earlobe may feel numb for six months to a year.
Contact your healthcare provider if you have:
A note from Cleveland Clinic
If you’ve had a stroke or have carotid artery disease, a carotid endarterectomy can improve your blood flow and help prevent a future stroke. You and your healthcare provider can decide if this surgery is right for you. Even if it is, you’ll have more success at managing carotid artery disease if you improve your diet, exercise more and bring down your stress level. Be sure to go to your follow-up appointments and keep taking your prescribed medicines, too.
Last reviewed by a Cleveland Clinic medical professional on 11/22/2021.