How is carotid artery surgery performed?

Your carotid artery surgery will be performed in a hospital using one of the following approaches:

  • Catheter surgery is a form of minimally invasive surgery used for carotid angioplasty and stenting. It involves inserting a catheter through a vessel in a groin or elbow. X-ray imaging guides the catheter tip to the blocked area of the carotid artery. Your doctor performs the angioplasty using a balloon, laser or drill to open your artery. Your doctor can also place a stent using the catheter. A stent is a cylinder-like tube made of thin mesh. Stents remain in place to keep your artery open after angioplasty.
  • Open surgery is used for carotid endarterectomy. Your surgeon makes an incision or cut in your neck to expose the diseased part of your carotid artery. Your surgeon either clamps your carotid artery closed or places a temporary shunt around your artery. The next step involves cutting open the diseased part of your artery and removing the inner lining, including the plaque buildup. Your surgeon closes your artery—sometimes this requires a “vein patch”—and unclamps it or removes the shunt. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than catheter surgery because it requires cutting and displacement of muscle and other tissues. Despite this, open surgery may be a safer or more effective method for some patients.

Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, and general health. Learn about the different types of carotid artery surgery and ask why your doctor will use a particular type for you.

Types of anesthesia that may be used

Your doctor will perform carotid artery surgery using either general anesthesia or regional anesthesia, depending on the specific procedure. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery. 
  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.  For carotid artery surgery, your doctor will use local anesthesia to numb the incision area in your groin or elbow where he or she inserts the catheter. Your doctor may ask you questions during the procedure. This will help monitor your brain’s response to decreased blood supply if your carotid artery is clamped shut. 

What to expect the day of your carotid artery surgery

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
  • A surgical team member will start an IV. 
  • The anesthesiologist or nurse anesthetist will start your anesthesia.
  • A tube is placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.