Carotid endarterectomy

Carotid endarterectomy is a surgical procedure to unblock a carotid artery. The carotid arteries are the main blood vessels that supply the head and neck.

Carotid endarterectomies are carried out when one or both carotid arteries have become narrowed because of a build-up of fatty deposits (plaque). This is known as carotid artery disease or carotid artery stenosis.

If a narrowed carotid artery is left untreated, the blood flow to the brain may be affected, resulting in a:

• stroke – a serious medical condition that can cause brain damage or death, or 
• transient ischaemic attack (TIA) – sometimes known as a "mini-stroke", a TIA is similar to a stroke but the signs and symptoms are temporary and usually disappear within 24 hours

Each year around 150,000 people have a stroke in the UK. About 45,000 of these are caused by narrowing of the carotid arteries. About 15,000 people have a severe narrowing that requires an operation.

Carotid endarterectomy can significantly reduce the risk of a stroke in people with severely narrowed carotid arteries. In people who have previously had a stroke or a TIA, their risk of having another stroke or TIA within the next three years is reduced by a third after surgery.

Read more about when carotid endarterectomy is needed.

About the procedure

The carotid endarterectomy procedure can be carried out using local anaesthetic or general anaesthetic. Local anaesthetic is often preferred because it means your surgeon can monitor the response of your brain to the changes in blood flow during surgery.

During the procedure, a 7 to 10cm (2.5 to 4 inch) incision will be made between the corner of your jaw and your breastbone. A small incision is then made along the narrowed section of artery and the fatty deposits that have built up there are removed.

The artery is then closed with stitches or a patch and your skin is sealed with stitches.

Read more about getting ready for carotid endarterectomy and how carotid endarterectomy is performed.

What happens after the procedure

You will usually be moved to the recovery area of the operating theatre after a carotid endarterectomy so your health can be monitored. Most people are well enough to go home within about 48 hours of the procedure.

In most cases, the only problems experienced after the operation are temporary numbness or discomfort in the neck. However, there is a small risk of serious complications as a result of the procedure, including stroke and death.

Nevertheless, this risk is much lower than in people with carotid artery disease who have not had the operation.

Read more about recovering from carotid endarterectomy and the risks of carotid endarterectomy.

Are there any alternatives?

A carotid endarterectomy is the main treatment for narrowing of the carotid arteries, but sometimes an alternative procedure called carotid artery stent placement may be available.

This is a less invasive procedure than a carotid endarterectomy because it does not involve an incision being made in the neck. Instead, a thin flexible tube is guided to the carotid artery through a small cut in the groin. A mesh cylinder (stent) is then placed into the narrowed section of artery to widen it and allow blood to flow through it more easily.

Read more about carotid artery stent placement.