Carotid endarterectomy - How carotid endarterectomy is performed

A carotid endarterectomy will either be carried out under general or local anaesthesia.

Anaesthetic

Anaesthetic is painkilling medication that allows surgery to take place without a patient feeling pain or discomfort.

If you have a general anaesthetic, you will be asleep throughout the procedure. You will remain conscious if you have a local anaesthetic, but the area on your neck will be numbed so you cannot feel any pain.

Studies comparing the results of carotid endarterectomies found no difference between the two types of anaesthetic. It will therefore be up to you, your surgeon and your anaesthetist (specialist in anaesthesia) to decide which type of anaesthetic to use.

Your surgeon may prefer to use local anaesthetic so that you remain conscious during the operation. This will allow them to monitor your brain's reaction to the decreased blood supply throughout the procedure.

The procedure

A carotid endarterectomy usually takes one to two hours to perform. If both of your carotid arteries need to be unblocked, two separate procedures will be carried out. One side will be done first and the second side will be done a few weeks later.

Once you are asleep or the area has been numbed, your neck will be cleaned with antiseptic to stop bacteria getting into the wound. If necessary, the area may also be shaved. A small incision will then be made to allow the surgeon to access your carotid artery.

During the procedure, your surgeon will decide whether to use a temporary shunt to maintain adequate blood flow to the brain. A shunt is a small plastic tube that can be used to divert blood around the section of the carotid artery being operated on.

The decision to use a shunt is based on surgeon preference and the results of brain blood flow monitoring during the operation. A shunt will not usually be used if the carotid artery on the other side of the neck is supplying the brain with enough blood.

When the surgeon has access to the carotid artery, the artery is clamped to stop blood flowing through it and an opening is made across the length of the narrowing. If a shunt is to be used, it will be inserted now.

The surgeon will then remove the inner lining of the narrowed section of artery, along with any fatty deposits (plaque) that have built up.

Once the narrowing has been removed, the opening in the artery will then either be closed with stitches or a special patch. The majority of surgeons in the UK use a patch, but the choice is down to surgeon preference.

Your surgeon will then check for any bleeding. The incision in your neck will be closed after any bleeding has stopped. A small tube (drain) may be left in the wound to drain away any blood that might build up after the operation. This is usually removed the following day.

After the procedure

When the operation is finished, you will usually be moved to the recovery area of the operating theatre, where your health can be monitored to ensure you are recovering well.