Carotid Endarterectomy


Sarah Lewis, PharmD

What is a carotid endarterectomy?

A carotid endarterectomy is a surgery to remove plaque buildup from your carotid arteries. It is a treatment for carotid artery disease and can help prevent a stroke. Carotid endarterectomy involves opening the carotid arteries in your neck and removing the inner lining that has become diseased or damaged by plaque.

You have two carotid arteries, one on each side of your neck. They are the major arteries that carry blood from your heart to your brain. A buildup of plaque can narrow or block your carotid arteries. This is called carotid artery disease, and it puts you at risk of stroke.

A carotid endarterectomy is a major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a carotid endarterectomy.

Other procedures that may be performed

Your doctor may perform one or more diagnostic procedures in addition to a carotid endarterectomy. These procedures will tell your doctor how much plaque is in your carotid arteries. They include:

  • Carotid angiography is a procedure that allows your doctor to take a picture or image (called an angiogram) of your carotid arteries

  • Carotid ultrasound is a noninvasive, painless screening test that allows your doctor to examine your carotid arteries and evaluate the flow of blood through them.

Why is a carotid endarterectomy performed?

Your doctor may recommend a carotid endarterectomy if you have carotid artery disease. Carotid artery disease is a buildup of plaque inside your carotid arteries. This narrows your carotid arteries and can eventually block them completely. Carotid artery disease is a serious health condition because it puts you at risk of having a stroke. A stroke is a block in the flow of blood to your brain.

Your doctor may recommend a carotid endarterectomy if other less invasive treatments are not an option. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a carotid endarterectomy.

Your doctor may recommend a carotid endarterectomy if you have carotid artery disease and any of the following conditions:

  • Carotid artery stenosis of 60% or greater. Carotid stenosis is narrowing of your carotid arteries. Your doctor may decide that a carotid endarterectomy is a good preventive treatment for you if your carotid arteries have narrowed by 60% or more. This is true even if you do not have symptoms and have not had a stroke or a TIA.

  • Prior stroke

  • Prior TIA (transient ischemic attacks). TIAs are a group of stroke-like symptoms that generally resolve within 24 hours. However, they are warning signs that you are at risk of a severe stroke.

Who performs a carotid endarterectomy?

A vascular surgeon will perform your carotid endarterectomy. A vascular surgeon specializes in surgical treatment of diseases of the blood vessels.

How is a carotid endarterectomy performed?

A carotid endarterectomy is an open surgery performed in a hospital. Open surgery allows your surgeon to directly view and access the surgical area. Your surgeon will make an incision in your neck to expose the diseased part of your carotid artery. Your surgeon closes the carotid artery with a clamp or places a temporary shunt around your artery.

The next step involves cutting open the diseased part of the artery and removing the inner lining, including the plaque buildup. Your surgeon closes the artery and unclamps it or removes the shunt.

Open surgery causes a certain amount of trauma to tissues, so it generally takes some time to recover. Your surgeon will determine how long you need to stay in the hospital based on your procedure, age, medical history, and general health.

Types of anesthesia that may be used

Your surgeon will perform a carotid endarterectomy using either general anesthesia or regional anesthesia.

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will 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 a continuous drip of a 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. Because you are awake, your surgeon may ask you questions during the procedure. This will help monitor your brain’s response to decreased blood supply while your carotid artery is clamped shut.

What to expect the day of your carotid endarterectomy

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 that you understand and sign the surgical consent. It is important to verify the correct side of your neck with the operating staff.

  • 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 if possible. 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 receive.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube may be placed in your windpipe to protect and control your breathing. You will not feel or remember this or the surgery as they happen.

  • A team member will insert a catheter into your bladder to collect urine.

  • The surgical team monitors your vital signs and other critical body functions. This occurs throughout the surgery and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a carotid endarterectomy?

As with all surgeries, a carotid endarterectomy involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery

The general risks of surgical procedures include:

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clots, in particular a deep vein thrombosis (DVT). A DVT can travel to your lungs and cause a pulmonary embolism.

  • Infection 

Potential complications of carotid endarterectomy

Complications of carotid endarterectomy can be serious and include:

  • Bleeding in the brain and brain damage

  • Death

  • Heart attack

  • Hyperperfusion syndrome. This can occur when your brain receives normal blood flow after it has had low blood flow to it. A severe headache that improves when you are upright is a classic symptom.

  • Low blood pressure, which is usually t