Carotid Endarterectomy

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What is a carotid endarterectomy?

Carotid [kuh-ROT-id] surgery, also called carotid endarterectomy [en-dahr-tuh-REK-tuh-mee], is a treatment option for carotid artery stenosis [sti-NOH-sis]. Stenosis occurs when plaque [plak] builds up in and narrows the carotid arteries (the blood vessels in your neck that carry blood to the brain). 

The carotid arteries are the blood vessels located in the neck (on either side of your windpipe) that help supply blood to the brain, head, and face.

Your doctor may recommend carotid surgery if one or both of your carotid arteries are blocked or narrowed. Although sometimes there are no symptoms, signs of plaque buildup can include: 

  • A TIA (mini-stroke) or stroke, with symptoms such as slurred speech, weakness, blurred vision, and confusion 
  • An abnormal sound in your artery (a bruit [broot]) that your doctor hears during a physical exam 

Your doctor will do tests to locate the blockage or narrowing and see how bad it is. If you have had a stroke, your doctor will assess whether the surgery will increase your risk of another stroke or help prevent it. 

You will meet with your doctor to talk about the risks and benefits (discussed below) of carotid surgery for your unique medical situation. If you have questions, be sure to ask. 

What are the risks and/or side effects?

Like any surgery, carotid surgery has risks. Yet complications are rare. Risks and potential complications of carotid surgery include: 

  • Severe reaction to the anesthesia used during surgery 
  • Bleedingor infection at the surgery site 
  • Blood clotsor bleeding in the brain 
  • Stroke, seizures, or brain damage (rare) 
  • Heart attack
  • Injury to nerves, esophagus, or trachea (windpipe), which can lead to hoarseness or swallowing difficulty 
  • Plaque building up again in the arteries 

What are the benefits?

Carotid surgery removes the plaque from the carotid arteries, improving blood flow to the brain. This can help reduce the risk of a future stroke.

How do I prepare?

To prepare for this procedure, you should:

  • Tell your doctor about all the medicines you take. This includes prescription medicines, over-the-counter medicines (such as cough syrup or allergy pills), inhalers, patches, herbal remedies, and vitamin supplements. Be sure to tell your doctor if you are allergic to any medicines. 
  • Follow your doctor’s directions about your medicines. Prior to surgery, you may need to stop taking some types of blood thinners or any medicine that makes it harder for your blood to clot. You may need to adjust your medicine if you have diabetes. Always check with your doctor before you stop taking any medicines. 
  • You will spend 1 to 2 nights in the hospital after your procedure. Bring items with you (such as a robe, slippers, and a toothbrush) that will make you more comfortable during your stay.
  • Follow your doctor’s directions about eating and drinking before surgery. You will likely need to stop eating or drinking after midnight the night before surgery. If you usually take medicine in the morning, ask your doctor or nurse for instructions. 
  • Tell your doctor or hospital staff if you have a cold, flu, or other illness the day of the surgery.
  • Tell your doctor if you are or may be pregnant.

How is it done?

On the day of your surgery: 

  • You’ll change into a hospital gown. If necessary, hair on your neck near the surgery site will be clipped or shaved. 
  • Your doctor will check in with you and mark the site for the surgery. 
  • You will have an IV (intravenous) line placed in your arm or hand to give you medicine. 
  • You might have a catheter [KATH-ih-tur] (a thin, flexible tube) placed into an artery in your wrist, elbow, groin, or foot to monitor your blood pressure during the procedure. 

The surgery usually takes about 2 to 4 hours. Here’s what happens during the surgery: 

  • You will get medicine to make you sleep. You won’t feel or remember the surgery. You will also get antibiotics to reduce the risk of infection. 
  • Other devices will be attached to keep track of your heart rate, blood pressure, breathing, and possibly your brain activity. 
  • You will lie on a surgical table with your head turned to the side on a padded support. 
  • The surgeon will make an incision (cut) in your neck. 
  • Blood flow to the artery will be stopped temporarily. A thin tube (shunt) may be used to change the route of blood to bypass the blockage. Your other carotid artery will continue to send blood to your brain. 
  • The surgeon will open up the blocked artery and clean out the plaque buildup. 
  • The surgeon will close the cleaned artery. A “patch” graft may also be used. 
  • The surgeon will then close the incision in your neck. 

When will I know the results?

You will be taken to an intensive care unit where healthcare providers will check on your blood pressure, breathing, wound, and how alert you are. You will likely stay in the hospital for 1 or 2 days. 

Make sure to talk to your doctor before your surgery, as well as during your recovery, to get a better idea of what to expect in terms of results. If you have any questions, make sure to ask your doctor about them.

What are follow-up requirements and options?

After your surgery:

  • You will be taken to an intensive care unit where healthcare providers will check on your blood pressure, breathing, wound, and how alert you are. 
  • You may have a temporary tube placed in your neck that drains fluid or blood from the incision. 
  • You will likely stay in the hospital for 1 or 2 days. 

After you go home: 

  • Follow your doctor’s advice to manage pain. Your neck may be sore, and it may be hard to swallow. Your doctor will prescribe medicine for pain. Eating softer foods can help. 
  • Take all medicines as directed by your doctor. This may include an antiplatelet [an-tahy-PLEYT-lit] medicine that helps prevent blood clots. 
  • Limit swelling and pain. For the first week, keep your head propped up on pillows when you are lying down to limit swelling. 
  • Don’t drive until your doctor says it’s okay. 
  • Limit strenuous activity for a few weeks. Don’t lift heavy objects, and don’t do any strenuous exercise until your doctor says it’s okay. You can go back to work and normal activities when your doctor says it’s okay. 
  • Watch for symptoms. Pay attention to certain changes in how you feel, especially neck swelling or a headache on the side where the procedure was done. Let your doctor know if you notice any of these symptoms. Call your doctor if you notice any:
    • Signs or symptoms of infection near your incision, including a fever over 101° F, redness, swelling, discharge, or pain that gets worse.
    • Coughing, difficulty breathing, or shortness of breath.
    • Chest pain or discomfort.
  • If you’ve had a stroke, you’ll have additional treatment such as medicines or stroke rehab.
  • Call 911 immediately if you have any of the following symptoms:
    • Memory loss, dizziness, or difficulty breathing.
    • A headache on the side where the procedure was done.
    • Any other headache that is sudden or severe.
    • If it becomes difficult to swallow, and if it gets worse and worse.

Carotid surgery, also called carotid endarterectomy is a treatment option for carotid artery stenosis. Stenosis occurs when plaque builds up in and narrows the carotid arteries (the blood vessels in your neck that carry blood to the brain).