A Guide to Carotid Artery Surgery

Medically Reviewed By John A. Moawad, MD, FACS

Carotid artery surgery helps restore blood flow to your brain by removing plaque from the carotid arteries. It is used to treat carotid artery disease and may help prevent stroke. However, as with any surgery, it has benefits and possible risks. You have two carotid arteries, one on each side of your neck. They are major arteries that carry blood from your heart to your brain. 

Carotid artery disease is a narrowing of your carotid arteries caused by a buildup of plaque that hardens. It is also referred to as carotid artery stenosis and can put you at risk of stroke.

Treatment with surgery can effectively reduce the risks associated with carotid artery disease. Your medical team can discuss the procedure and its risks and benefits to optimize your personal outcome.

This article explains carotid artery surgery including its types, outlook, and who may benefit. It also discusses how the procedure is performed, how to prepare, and what to expect during recovery.

Who may benefit from carotid artery surgery? 

A clinician feels the sides of a person's neck.
The Good Brigade/Getty Images

Doctors may not recommend carotid artery surgery for everyone with carotid artery disease. This is because surgery carries risks, and less invasive treatment options may be effective.

However, doctors may recommend carotid artery surgery if:

  • other treatments are not effective
  • you who have severe carotid artery disease
  • you previously had a stroke or transient ischemic attack (TIA) and have moderate or severe carotid artery disease

Read more about carotid artery disease.

How do I prepare for carotid artery surgery?

Taking the following steps to prepare for carotid artery surgery can improve your comfort level and outcome:

  • Ask your medical team any questions you may have.
  • Attend all your scheduled appointments for preoperative testing.
  • If you have high blood pressure, talk with your doctor about managing it before and after surgery.
  • Stop smoking if you smoke.
  • Maintain a moderate weight.
  • Ask your medical team about eating and drinking guidance before surgery.
  • Follow all other instructions for surgery preparation that your medical team provides.
  • Provide your medical team with an up-to-date list of your:
    • medical diagnoses
    • treatments, medications, and supplements, including their names and dosages
    • allergies

Make sure to include any blood-thinning medications you may be taking in your list, such as aspirin.

Follow your surgeon’s advice closely for continuing or stopping your medication. This can vary per person and depending on the medication.

Your medical team will help you get ready before surgery. This can involve:

  • doing any pre-surgery tests
  • discussing any questions and signing consent forms
  • discussing your medical history with an anesthesiologist
  • putting on a medical gown
  • shaving the surgical area

How is carotid artery surgery performed?

Carotid artery surgery is performed in a hospital and can include one of the following two procedures.

Carotid angioplasty and stenting

This is a less invasive procedure that may be beneficial for people at higher risk of complications.

Before surgery, your medical team will provide you with an anesthetic to stop you from feeling pain. This can include Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source local or general anesthesia.

During the procedure, the surgeon will insert a catheter through a blood vessel in the neck or elbow. They will then use X-ray imaging to guide the catheter to the affected artery. The surgeon can then widen the artery and place a stent.

A stent is a tube made of thin mesh that remains in place after your surgery.

Carotid endarterectomy

This procedure involves making a small cut to remove the part of the artery lining damaged by plaque buildup.

Before surgery, an anesthesiologist will provide Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source you with local anesthesia and sedation or general anesthesia.

Carotid endarterectomy involves open surgery and is usually performed in the following steps:

  1. The surgeon will make a small cut in the neck after cleaning the area.
  2. They will then clamp the artery to stop its blood flow and open it.
  3. The surgeon may place a small tube called a shunt to help support blood flow to the brain.
  4. They will then remove the inner lining and plaque deposits from the affected area of the artery.
  5. Afterward, they will close the artery with stitches or a clinical patch before closing the neck.
  6. Finally, the surgeon may place a temporary tube in the wound. This allows any blood to drain away over the next day or so.

This procedure typically takes around 1–2 hours. However, the anesthesia may continue to affect you for a few hours after surgery. As a result, doctors may schedule around 3 hours for your procedure.

You may require an endarterectomy on both arteries. In this case, your medical team will schedule two separate surgeries a few weeks apart.

What is the recovery process like?

Recovery from carotid artery surgery is a gradual process that can range in time, depending on:

  • the type of surgery and anesthesia
  • your general health
  • your age
  • whether you experience any complications

A hospital stay of around 2 days is typical. However, this can vary per person.

Once you are discharged from the hospital, your medical team will provide you with instructions for your recovery. The exact instructions they provide can depend on your personal circumstances. Examples include:

  • taking a few weeks off work
  • limiting physical activity for a few weeks after surgery, such as sports and manual labor
  • avoiding driving until you receive medical approval

Inform your medical team about all your usual activities. They can discuss instructions for returning to them after surgery.

Your team will also provide other care instructions, such as:

  • when you can eat and drink after surgery
  • what medications you can take, such as pain relief medications
  • when to schedule follow-up appointments
  • how to care for your wound

Contact your doctor for advice if you have any questions about your recovery.

What are the risks and complications of carotid artery surgery?  

As with all surgeries, carotid artery surgery involves Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source risks and possible complications, such as Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

  • anesthesia reaction, such as an allergic reaction or problems with breathing
  • bleeding, which can lead to shock
  • blood clots
  • infection
  • scarring
  • artery injury
  • nerve injury
  • stroke
  • heart attack
  • restenosis, whereby the artery narrows again
  • hyperperfusion syndrome, whereby increased blood flow in the artery causes symptoms such as swelling or bleeding in the brain

What is the outlook after carotid artery surgery?

The outlook after carotid artery surgery can vary per person. You may be more likely to experience complications if you:

  • are older
  • smoke
  • have previously had a stroke or TIA
  • have carotid artery disease in both carotid arteries
  • have other underlying health conditions

However, carotid artery surgery can significantly reduce your risk of more serious conditions and complications. Also, the risk of stroke and death may be low.

A 2021 randomized trial Trusted Source The Lancet Highly respected journal, Expert written journal, Peer reviewed journal Go to source looked at the outlook for 3,625 people who underwent either carotid artery stenting or carotid endarterectomy. Results suggest that 1% of participants experienced a disabling stroke or died within 30 days of surgery. Additionally, 2% of participants experienced a non-disabling stroke.

With proper medical care, there may not be significant differences in the rates of complications between the conditions.

If you have any questions about your outlook, contact your doctor for advice. They can inform you of the risks and benefits for your individual situation.

When should I contact my doctor?

It is important to keep all your follow-up appointments after carotid artery surgery. Make sure to reschedule any missed appointments as soon as possible.

Contact your doctor for questions and concerns between appointments.

Call 911 or seek immediate medical advice for any of the following symptoms after surgery:

There is a small risk Trusted Source The Lancet Highly respected journal, Expert written journal, Peer reviewed journal Go to source of stroke or blood clots after carotid artery surgery. Call 911 for any of the following symptoms:

  • numbness or weakness on one side of your body or face
  • difficulty speaking
  • problems with memory or vision
  • difficulty balancing, walking, or coordinating your movement
  • severe pain
  • skin discoloration or swelling
  • any other sudden or severe symptoms, such as severe headache or sudden functional changes

Learn more about the symptoms of stroke and blood clots.


Carotid artery surgery refers to surgeries that can help treat carotid artery disease. This is a type of artery narrowing due to plaque buildup.

Types of surgeries include carotid angiography and stenting and carotid endarterectomy. Carotid angiography and stenting involves using a catheter to place a stent and widen the artery. With carotid endarterectomy, a surgeon cuts open the artery to clean out plaque buildup.

Both procedures may significantly reduce the risk of stroke. However, like any other surgery, they both carry risks, such as infection or blood clots.

Your medical team can discuss any questions or concerns you may have. They can also help you identify whether surgery may be effective for you.

Call 911 for any severe symptoms after surgery, such as bleeding, confusion, or pus.

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Medical Reviewer: John A. Moawad, MD, FACS
Last Review Date: 2023 Jun 19
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