Carotid Endarterectomy

The carotid arteries in the neck carry most of the blood supply to the brain. When plaque narrows one of them, fragments can break loose and travel upward, blocking a vessel in the brain and causing a stroke or a TIA. Carotid endarterectomy removes that plaque directly: the artery is opened and the diseased lining is peeled out, then the vessel is closed — often with a patch to keep it wide.

It is one of the most studied operations in vascular surgery, and in the right patient it clearly reduces future stroke risk.

The decision depends on how narrow the artery is and whether it has already caused symptoms:

Symptomatic narrowing — a stroke or TIA on the same side within the last six months, with 50 to 99 percent stenosis. Benefit is greatest here, and greatest when surgery is done within about two weeks of the event, so this evaluation is not something to postpone.

Asymptomatic narrowing — generally 70 percent or greater, where surgery is considered against the patient's life expectancy and surgical risk. Modern medical therapy has improved considerably, so this is a genuine discussion rather than an automatic referral.

A completely blocked carotid is not treated with endarterectomy, since there is no channel to restore.

Alternatives include carotid artery stenting and TCAR, a hybrid approach that reverses blood flow away from the brain while a stent is placed through a small incision at the base of the neck. Which is appropriate depends on your anatomy, age, and medical conditions.

Surgery takes roughly one to two hours, under general or regional anesthesia. An incision is made along a skin crease at the side of the neck. Blood flow is temporarily controlled while the artery is opened and the plaque removed; a temporary shunt is sometimes used to maintain flow to the brain during that period. Brain function is monitored throughout.

Most patients stay one night, often with blood pressure watched closely, since it can swing in either direction in the first hours.

• Neck soreness and difficulty swallowing for a few days are common
• Numbness around the incision and along the jaw or earlobe is expected from small sensory nerves and usually improves over weeks to months, though a patch can persist
• Hoarseness or a weak voice can occur from nerve irritation and typically resolves
• Most people return to light activity within a week or two, avoiding heavy lifting and driving until cleared

Take your aspirin and statin as prescribed — they are as important to the long-term result as the operation itself, and stopping them raises the risk of the artery renarrowing.

Call 911 for any stroke symptoms: sudden weakness or numbness on one side, facial droop, trouble speaking or understanding, sudden vision loss, or severe unexplained headache. Also seek urgent care for rapid neck swelling, difficulty breathing, or bleeding from the incision.

Stroke or heart attack around the time of surgery, bleeding or a neck hematoma, and cranial nerve injury affecting the tongue, voice or face — usually temporary. Renarrowing can occur over years, which is why surveillance ultrasounds are scheduled afterward.