Carotid endarterectomy is a surgical procedure performed to reduce the risk of stroke in patients with carotid artery disease. This condition occurs when fatty deposits (plaque) build up in the carotid arteries, the major blood vessels that supply blood to the brain. Over time, these deposits can narrow or block the arteries, significantly increasing the risk of stroke. Carotid endarterectomy removes this plaque, restoring normal blood flow and preventing future cerebrovascular events.

One of the most effective surgical treatments for this condition is carotid endarterectomy. This procedure involves the careful removal of the plaque from inside the artery wall to restore normal blood flow and significantly reduce the risk of future strokes. Carotid endarterectomy is particularly recommended for individuals with moderate to severe narrowing of the carotid arteries, especially if they have experienced symptoms such as sudden weakness, speech difficulty, or vision changes classic warning signs of a TIA or minor stroke.

Understanding Carotid Artery Disease

Before diving into the surgical process, it’s essential to understand carotid artery disease. The carotid arteries, located on each side of your neck, are crucial for delivering oxygen-rich blood to the brain. When these arteries become narrowed or blocked due to atherosclerosis (plaque buildup), it can lead to a transient ischemic attack (TIA) or a full blown stroke.

Symptoms may include sudden weakness, numbness on one side of the body, difficulty speaking, dizziness, or temporary vision loss. However, many patients remain asymptomatic until a significant blockage occurs.

When the narrowing is severe typically more than 70% a carotid endarterectomy may be recommended as a preventive measure.

Why Carotid Endarterectomy is Performed?

Carotid endarterectomy is primarily performed to prevent stroke in patients with significant carotid artery stenosis. The procedure is recommended in the following scenarios

Symptomatic patients with 50–99% blockage.
Asymptomatic patients with 70–99% blockage.
Those who have had a recent stroke or TIA due to carotid artery disease.

It is typically considered when medical management (like statins and lifestyle changes) is not sufficient or when imaging tests reveal a high risk of future stroke.

Preparing for the Procedure

Before the surgery, the patient undergoes several diagnostic tests to assess the severity of the blockage. These may include

Carotid ultrasound to evaluate blood flow.
CT angiography (CTA) or magnetic resonance angiography (MRA) for detailed imaging.
Electrocardiogram (ECG) and blood tests to ensure the patient is fit for surgery.

Patients are usually advised to stop eating or drinking several hours before the surgery. They may be asked to stop taking certain medications like blood thinners, depending on the surgeon’s guidance.

Step by Step Procedure of Carotid Endarterectomy

Carotid endarterectomy is generally performed under local or general anesthesia and takes about 1.5 to 2 hours. Here’s how the procedure is typically carried out

Anesthesia and Positioning :- The patient is given either general anesthesia (where they’re fully asleep) or local anesthesia (numbing the neck area while the patient remains awake). The choice depends on the patient’s health status and the surgeon’s preference. The patient is positioned on their back with the head turned away from the side to be operated on.
Incision and Exposure :- A small incision is made along the side of the neck where the carotid artery is located usually along a natural skin crease to minimize scarring. The surgeon carefully moves aside muscles and nerves to expose the carotid artery.
Clamping the Artery :- Once the artery is exposed, clamps are placed on the common, internal, and external carotid arteries to stop blood flow temporarily. To maintain cerebral blood flow during the procedure, a temporary shunt (a small tube) may be inserted.
Removing the Plaque :- The surgeon then opens the artery lengthwise and carefully removes the plaque buildup from the inner walls. This step, called endarterectomy, involves scraping away the atherosclerotic deposits to restore normal blood flow.
Closing the Artery :- After removing the plaque, the artery is either stitched closed directly or closed using a patch (often made from synthetic material or a vein graft). This helps widen the artery and reduce the risk of re narrowing.
Removing Clamps and Closing the Skin :- The clamps and shunt are removed once blood flow is restored, and the surgeon ensures there are no leaks or complications. The incision is then closed using sutures or surgical glue, and a bandage is applied.

Recovery After Carotid Endarterectomy

After the procedure, patients are moved to a recovery room for monitoring. Vital signs, neurological function, and the incision site are closely observed. Most patients stay in the hospital for 1–2 days, depending on their condition.

Pain is usually mild and can be managed with medications. Patients are typically encouraged to walk and resume light activities within a day or two.

A follow up ultrasound may be scheduled to ensure that the artery remains open. Long term medication such as antiplatelets (e.g., aspirin or clopidogrel), cholesterol-lowering drugs, and lifestyle changes are essential to prevent future blockages.

Risks and Complications

While carotid endarterectomy is generally safe and effective, like all surgeries, it carries some risks. Possible complications include :-

Stroke (from dislodged plaque or reduced blood flow during surgery)
Heart attack
Nerve injury (leading to hoarseness, difficulty swallowing, or numbness)
Infection or bleeding at the surgical site
Re narrowing of the artery (restenosis)

However, in skilled hands, the benefits of the surgery particularly stroke prevention far outweigh the potential risks for most eligible patients.

Carotid Endarterectomy vs. Carotid Artery Stenting

Carotid artery stenting is a less invasive alternative where a small mesh tube (stent) is placed in the artery to keep it open. While stenting is suitable for some patients, especially those at high surgical risk, carotid endarterectomy remains the gold standard for long-term outcomes, especially in older patients or those with extensive plaque buildup.

Your vascular surgeon will recommend the most appropriate treatment based on your individual condition and risk factors.

Conclusion

Carotid endarterectomy is a proven and effective surgical procedure that significantly reduces the risk of stroke in patients with severe carotid artery narrowing. By removing plaque and restoring normal blood flow to the brain, this surgery offers long term protection and improved quality of life.