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Carotid Endarterectomy

Surgery Overview

A carotid endarterectomy (say "kuh-RAW-tid en-dar-tuh-REK-tuh-mee") is done to remove fatty buildup (plaque) from one of the carotid arteries. There are two of these arteries. One runs along each side of the neck. They supply blood to your brain. When plaque builds up in either one, it can make it hard for blood to flow to the brain. This surgery may lower your risk of stroke.

The doctor will make a cut (incision) in your neck. Then the doctor will make a cut in the carotid artery and take out the plaque.

Next, the doctor will close the cut in the artery with stitches. Or the doctor may sew a man-made patch over this cut. This will make the artery wider. It also helps keep it from getting narrow again. Then the doctor will use stitches to close the cut in your skin. It will leave a scar. But the scar will fade with time.

You will probably go home the day after surgery. You may be able to go back to work or your usual activities in 1 to 2 weeks.

How It Is Done

Carotid endarterectomy procedure

During carotid endarterectomy, your surgeon:

  • Makes a cut in your neck just below the jaw.
  • Opens the carotid artery and carefully removes the plaque.
  • May sew (graft) a man-made patch onto the carotid artery to widen or repair the artery.
  • Closes the artery and skin incisions with stitches.

What To Expect

You may need to stay in the hospital for a day or two.

You can start to do most of your normal activities again within a week, but you may feel more tired than usual. For a few weeks, you'll need to avoid activities that make you work hard, like doing intense exercise or lifting anything heavy. You may have some aching in your neck for up to 2 weeks.

Why It Is Done

Carotid endarterectomy is done to help lower your risk of stroke.

Your doctor may recommend this procedure based on certain things. These include:footnote 1, footnote 2

  • The amount of narrowing (stenosis) in your carotid arteries. A procedure may be an option if the narrowing is 50% or more.
  • Whether you had a stroke or TIA within the past 6 months. If you have not had a stroke or TIA, it's less clear that the procedure will help you.
  • Whether you have a low risk (less than 6%) of stroke or death from a procedure.

Your doctor can help you understand your risk of stroke and whether endarterectomy might be an option for you.

Learn more

How Well It Works

If you have not had a TIA or stroke

For people who haven't had a stroke or TIA, it's not clear when endarterectomy might be a good choice. The surgery may help prevent a stroke in the long run. But in the short term, it increases the risk of stroke and death. Medicine and lifestyle changes may work as well as surgery to prevent a stroke. And they don't have the risks of surgery.

Endarterectomy may be an option if you have more than 60% to 70% narrowing and you have a low risk of a serious problem from the surgery.footnote 3

It's not clear that this surgery will reduce your stroke risk more than medicines and lifestyle changes alone. Studies are being done to compare current medical therapy with endarterectomy.

If you've had a TIA or stroke

An endarterectomy can help lower your risk of stroke if your carotid artery is narrowed by 50% or more. People with less than 50% narrowing do not benefit from surgery.footnote 4

You may benefit most from endarterectomy if it is done within 2 weeks of the stroke or TIA. This is when the risk of another stroke is highest.

Risks

The risks of carotid endarterectomy include:

  • Infection.
  • Breathing problems.
  • High blood pressure.
  • Nerve damage that could cause serious problems, like trouble swallowing.
  • Bleeding in the brain.
  • Stroke, heart attack, or death.

The risks of a procedure depend on things like your age and your overall health. Who does the procedure and where it is done are also important.

Related Information

References

Citations

  1. Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.
  2. Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.
  3. Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.
  4. Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.

Credits

Current as of: August 31, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Martin J. Gabica MD - Family Medicine
Adam Husney MD - Family Medicine
Robert A. Kloner MD, PhD - Cardiology

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