Carotid Endarterectomy (Stroke Prevention Surgery)

Carotid endarterectomy is a surgical procedure to remove the build-up of fatty deposits (plaque), which cause narrowing of a carotid artery and can lead to strokes.

The carotid arteries are the main blood vessels that supply the head and neck. Like every other artery, the carotid artery can be affected by the disease process known as atherosclerosis, commonly termed ‘furring up of the arteries”. This happens in everyone as part of ageing, but some factors can accelerate this ‘furring’ e.g., smoking, high blood pressure, high cholesterol or diabetes.

The process of atherosclerosis leads to the formation of fatty deposits in the lining of the arteries known as plaques. As well as leading to narrowing of the artery and restriction of blood flow, these plaques can sometimes rupture, triggering the formation of a blood clot. A piece of plaque or blood clot can break off and travel to the brain, resulting in:

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

A common form of TIA is amaurosis fugax in which there is a sudden (temporary) loss of vision on one side.

Each year in the UK more than 100,000 people have a stroke.

1 in 10 strokes or TIAs are caused by carotid artery narrowing.

All patients who have had a stroke, TIA or loss of vision due to carotid artery disease benefit from being on a blood thinner (anti-platelet drug like aspirin), a statin tablet and from having blood pressure tablets.

A 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, surgery reduces their risk of having another stroke or TIA within the next 3 years by a third.

Surgery is sometimes recommended for people who haven’t previously had a stroke or a TIA but are found to have severe narrowing.

Surgery isn’t recommended in cases where there’s minor narrowing (less than 50%).

It’s now thought the operation should be carried out as soon as possible after symptoms appear (ideally within 14 days). The benefit for carotid surgery falls away sharply 3 months after the initial event.

It’s therefore important to get immediate medical advice if you experience symptoms such as:

numbness or weakness in your face, arm or leg
speech problems
loss of vision in one eye

Find out more about when a carotid endarterectomy is needed

Preparing for surgery

Before having a carotid endarterectomy, your surgeon will discuss how you should prepare.

They may advise you to:

stop smoking – smoking increases your risk of developing a chest infection, can delay healing, and increase your risk of developing a blood clot
watch your weight – if you’re overweight, losing weight will be recommended, but as strenuous exercise could be dangerous, you’ll need to do this by dieting; your GP will be able to advise you about how to lose weight
think positively – a positive mental attitude can help you deal with the stress of surgery and help your recovery

About the procedure

A carotid endarterectomy can be carried out using either local anaesthetic or general anaesthetic.

The advantage of local anaesthetic is it allows the surgeon to monitor brain function while you’re awake. But there’s no evidence that either is safer or better.

During the procedure, a 7 to 10cm (2.5 to 4 inch) cut is made between the corner of your jaw and your breastbone.

A small cut is then made along the narrowed section of artery and the fatty deposits that have built up are removed.

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

After the procedure

You’ll usually be moved to the recovery area of the operating theatre for monitoring for about 3 hours, before returning to the vascular ward.

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.

But there’s a small risk of more serious complications, which can include stroke or death in 2 to 3% of cases.

Nevertheless, this risk is much lower than in people with carotid artery disease who haven’t chosen to have the operation.

Wound care

The wound on your neck will be closed with stitches, which may need to be removed later. Your surgeon will be able to advise you about this (sometimes dissolvable stitches or skin glue are used instead).

You may be left with a small scar running from the angle of your jaw to the top of your breastbone. The scar is usually about 7 to 10cm (2.5 to 4 inches) long and fades to a fine line after 2 or 3 months.

Driving

Your GP will be able to advise you about when it’s safe to drive after surgery, usually when you can safely carry out an emergency stop. For most people, this is between 2 to 3 weeks after the operation.

If you have had a stroke or transient ischaemic attack (TIA), you won’t be allowed to drive for a month afterwards.

If you have fully recovered, you don’t need to inform the DVLA unless you drive a lorry or a bus for a living however, you will need to inform your motor insurance company.

Work and exercise

Most people can return to work 3 to 4 weeks after having a carotid endarterectomy. Your surgeon or GP will be able to advise you further about returning to work.

Being active can help your recovery, but you shouldn’t overdo it. Your surgeon can advise you about how much exercise you can do and may recommend that you limit physical activity for a few weeks after having surgery. This includes manual labour and playing sports.

If your job involves manual labour, you should only perform light duties until you have fully recovered.

Alternative treatments

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

Insertion of a carotid stent is a less invasive procedure than a carotid endarterectomy because there’s no need to make a cut 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.

Current guidelines recommend that a carotid endarterectomy should be the first line of treatment for most people. This is because carotid stenting is associated with a higher risk of stroke during the procedure, particularly if it’s carried out in the first few days after symptoms appear.

Carotid stenting is an important alternative for people who are at higher risk of complications because of other medical problems.

Find out more about carotid artery stent placement

Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.