Carotid Artery Endarterectomy

by Amy Scholten, MPH

Definition

A carotid artery endarterectomy is surgery to remove fatty buildup (plaque) from this artery. The carotid artery carries blood through the neck to the brain. Plaque buildup can slow and stop blood from flowing through the artery.

Carotid Artery

Reasons for Procedure

This procedure helps restore proper blood flow to the brain. This will help to prevent strokes and transient ischemic attacks (TIAs). TIAs are mini-strokes.

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

Excess bleeding
Infection
Damage to the carotid artery or nerves in the neck
High blood pressure or low blood pressure
Stroke

Things that may raise the risk of problems are:

Smoking
How much the carotid artery is blocked
Blockage of the carotid arteries on both sides of the neck
Long-term diseases such as diabetes or obesity

What to Expect

Prior to Procedure

The surgical team may talk to you about:

Anesthesia options
Any allergies you may have
Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
Fasting before surgery, such as avoiding food or drink after midnight the night before
Whether you need a ride to and from surgery
Tests that will need to be done before surgery

Anesthesia

The doctor will give:

General anesthesia—you will be asleep
Local anesthesia—the area will be numbed

Description of the Procedure

An incision will be made in the skin along the side of the neck. The incision will run from behind the ear to above the breastbone. Clamps will be placed above and below the plaque on the carotid artery. Sometimes, a temporary bypass tube is used. The tube will maintain blood flow around the area that is being worked on.

The artery will be opened and cleaned of plaque. The artery will then be sewn back together. The clamps, and bypass tube, if used, will then be removed. A part of the carotid artery may need to be removed. In this case, an artificial graft or a piece of vein will be sewn in to replace it. The neck incision will be closed with stitches. A bandage will be placed over the site.

How Long Will It Take?

2 to 4 hours

Will It Hurt?

Pain and discomfort are common in the first week. Medicine and home care help.

Average Hospital Stay

The usual length of stay is 1 to 3 days. If you have problems, you may need to stay longer.

Post-procedure Care

At the Hospital

During your stay, the hospital staff will take steps to lower your risk of infection, such as:

Washing their hands
Wearing gloves or masks
Keeping your incisions covered

There are also steps you can take to lower your risk of infection, such as:

Washing your hands often and reminding visitors and staff to do the same
Reminding staff to wear gloves or masks
Not letting others touch your incisions

At Home

Recovery may take up to 2 weeks. Physical activity may be limited during this time. Diet changes can help prevent a return of plaque buildup.

Call Your Doctor

Call your doctor if you have any new symptoms or:

Signs of infection, such as fever and chills
Redness, swelling, excess bleeding, or discharge at the incision site
Lasting nausea or vomiting
Pain that you cannot control with the medicines
Severe headaches, swelling in the neck, or extreme sweating
Cough, problems breathing, or chest or arm pain
Drooping facial muscles or weakness, lightheadedness, or fainting
Problems thinking, speaking, seeing, or moving

If you think you have an emergency, call for medical help right away.

RESOURCES:

American Heart Association
http://www.heart.org

National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

References:

Baiu I, Stern JR. Carotid artery endarterectomy. JAMA. 2020;324(1):110.

Carotid artery stenosis repair. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/carotid-artery-stenosis-repair. Accessed August 31, 2021.

Carotid endarterectomy. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/treatments/16849-carotid-artery-disease-carotid-endarterectomy. Accessed August 31, 2021.

Questions and answers about carotid endarterectomy. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Stroke-Hope-Through-Research/Questions-Answers-Carotid-Endarterectomy. Accessed August 31, 2021.

Stroke treatments. American Heart Association website. Available at: https://www.stroke.org/en/about-stroke/types-of-stroke#. Accessed August 31, 2021

Last reviewed July 2021 by EBSCO Medical Review Board Nicole Meregian, PA
Last Updated: 8/31/2021

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