Carotid Endarterectomy
Carotid endarterectomy can help prevent stroke. Learn who can benefit from this procedure and how it's performed.

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Picture of bloode vessels in head Carotid Endarterectomy

What is a carotid endarterectomy?
Carotid endarterectomy is surgery to remove cholesterol plaque that has built up in the carotid artery in the neck. The carotid arteries - one on each side of the neck - carry blood from the heart to the brain. Plaque in the arteries can rupture and lead to a stroke.

Why does a carotid endarterectomy need to be done?
Endarterectomy is done to remove the plaque buildup that causes narrowing (stenosis) in the carotid artery. The procedure may be offered:

  • When the blockage is severe, even when it doesn't cause symptoms.
  • Following a stroke or transient ischemic attack, or TIA. In a TIA, or mini-stroke, symptoms completely disappear.

What tests lead up to the procedure?
There are different tests that look at your carotid arteries to see whether they are blocked. Your doctor may first listen to the blood flow in your neck with a stethoscope. Narrowing often creates a "swooshing" sound, called a bruit. If your doctor suspects narrowing, he or she will likely order more tests. Often an ultrasound is done next. This test uses sound waves to create a picture of the blood as it flows through the carotid arteries. Other imaging tests that may be done are computed tomography angiogram (CTA) and magnetic resonance angiogram. These tests allow the doctor to measure the plaque buildup in your carotid arteries and see how well the blood is flowing through them.

How is a carotid endarterectomy performed?
Before the procedure, you may be given general anesthesia, which puts you to sleep temporarily. Some surgeons prefer to do the operation while you are awake. They use local anesthesia, which numbs the area where the surgery will be performed so you will not feel any pain. If you have local anesthesia, you remain awake so the surgeon can check for any decreased blood flow to the brain. You will also be given medication to help you relax. After you get anesthesia, a small cut is made in the skin on the side of your neck. The carotid artery is then gently cut open and the plaque is removed. Then the artery and skin are closed with stitches.

How long does the procedure take?
The surgery usually takes about two hours. Most people go home within a few days if there are no major problems.

What are the risks?
There is a small risk that endarterectomy could trigger a stroke or heart attack. There may be a much greater risk of stroke if nothing is done for severe carotid artery stenosis.

Another risk is that your arteries will become clogged up again. This is called restenosis, and is most likely to occur if you smoke cigarettes.

Another rare complication is temporary nerve damage. This can cause hoarseness, trouble swallowing and numbness. Usually this problem clears up on its own. Bleeding and infection at the incision site and other general risks related to surgery are also possible, although rare.

By Louis Neipris, MD, Staff Writer
Created on 10/18/2005
Updated on 09/24/2010
Sources:
  • National Heart Lung and Blood Institute. Carotid endarterectomy surgery.
  • American Heart Association. Carotid bruit.
  • Society for Vascular Surgery. Carotid endarterectomy.
  • American Heart Association. What is carotid endarterectomy?
Copyright © OptumHealth.
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