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A carotid endarterectomy is a surgical procedure to remove fatty deposits called plaques from the carotid arteries. These are the arteries on the sides of your neck that supply blood to your head and brain. A buildup of plaque in the carotid arteries can cause the arteries to narrow, a condition known as carotid artery stenosis or carotid artery disease.
Left untreated, carotid artery stenosis can lead to a transient ischaemic attack (TIA) or stroke. This occurs when the carotid artery becomes blocked, or a blood clot forms in the artery and a piece breaks off and goes to the brain.
TIAs, sometimes called mini-strokes, normally resolve within twenty-four hours. A severe stroke can result in permanent brain damage or death. This page explains what carotid endarterectomy is, what happens during the procedure and what to expect during your recovery.
Call or book online today to arrange a consultation to discuss private carotid endarterectomy with a consultant of your choice at Circle Health Group.
Your consultant may recommend a carotid endarterectomy if you:
- Have had a previous TIA or mild stroke
- Have severe carotid artery stenosis
Are there any alternatives to carotid endarterectomy?
If carotid endarterectomy isn't suitable for you, your consultant may recommend an alternative procedure called carotid angioplasty and stenting.
During this procedure, a thin, hollow tube with a small balloon attached is inserted into a blood vessel in your groin. When it reaches the narrowed artery, the balloon is inflated to widen it and a mesh tube called a stent is put in place to prevent it from narrowing again.
In addition to surgical procedures to treat carotid stenosis, your consultant will prescribe medications called blood thinners to prevent blood clots from developing and blood pressure medication if necessary. You will also be advised on lifestyle changes such as stopping smoking and changes to your diet.
Carotid endarterectomy can significantly reduce the risk of further stroke in patients who have had a previous TIA or mild stroke.
It may also reduce the risk of TIA or stroke in people with carotid stenosis who do not have symptoms and have not had a previous TIA or stroke.
At your first consultation, you will be seen by a consultant vascular surgeon, a doctor specialising in surgery of the blood vessels and circulation.
Your consultant will ask you about your symptoms, general health, and medical history, and perform a physical examination. They may look at any previous tests or scans you have had or arrange these on the day. These tests help your consultant assess the severity of the stenosis and may include ultrasound, computed tomography angiography (CTA), cerebral angiography or magnetic resonance angiography (MRA).
At Circle Health Group, your first appointment is very important as it's where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have.
At the end of your appointment, your consultant will decide if carotid endarterectomy is a suitable treatment for you based on your diagnosis, general health, and medical history. They will explain the procedure to you including what happens during the surgery, any risks, and complications and what to expect during your recovery. Your consultant will also answer any questions you have at this time.
Your consultant will tell you everything you need to do in preparation for your carotid endarterectomy. If you have any questions about how to prepare for your procedure, speak to your consultant or call the hospital for advice.
Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking.
Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.
You may need to stop eating and drinking a few hours before your surgery. Check with your healthcare team when you can eat and drink before your procedure.
What lifestyle changes can I make before my surgery?
Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.
To make sure you are as healthy as possible before your surgery:
- Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
- If you smoke, you must stop before your endarterectomy
- Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
- Take regular exercise
Carotid endarterectomy may be performed under general or local anaesthetic. A general anaesthetic is where you are put into a deep sleep for your surgery and a local anaesthetic means you'll be awake during the procedure, but will not feel any pain (you may also be given medication to relax you).
Once your anaesthetic has taken effect, your consultant will make an approximately 10cm incision (cut) in the side of your neck to expose the diseased artery.
Another incision is made into the artery and a tiny tube called a shunt is used to divert blood around the area to the brain.
Your consultant will remove the plaque build-up from the diseased artery.
The shunt is removed, and the incision is closed. A patch may be used to widen the artery and prevent it from narrowing again.
A sterile dressing is applied to the incision site. A small drain may be inserted to drain any blood from the operation. This is usually removed the following morning.
Carotid endarterectomy normally takes around two hours.
Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether or not there were any complications during your surgery.
Your consultant will be able to give you a more personalised estimated recovery timeline based on your individual circumstances.
Recovering in hospital
After your surgery, you will be taken to the recovery room where you will be monitored closely until the effects of the anaesthetic have worn off. You will then be taken to your room.
You will be encouraged to get out of bed and walk around as soon as you are ready after surgery.
You may experience some pain around your incision after your surgery. Your doctor will prescribe painkillers to help with this.
You will normally need to spend one or two nights in hospital after your carotid endarterectomy.
You will not be able to drive yourself home from hospital after your carotid endarterectomy. Please make arrangements for someone to come and collect you and accompany you home.
After you go home
You should rest for the first few days after your surgery. After this, you can gradually build up your activity level over the next few weeks. Stop if you feel tired or have pain.
You may have stitches that need to be removed after surgery. Your healthcare team will advise you on this. In some cases, your incision may be closed with glue or dissolvable stitches which don't need to be removed.
Your consultant will give you instructions on how to care for your surgical wound. It's important to keep your incision site clean and dry. Use mild soap and water to clean the area and pat dry with a clean towel. Don't apply any creams or lotions to your incision wound.
You may experience numbness in your neck, jawline, and earlobe for up to a year after your procedure.
How soon can I go back to work?
When you can go back to work after your surgery depends on your individual recovery and the type of job you do. Most people return to work around three to four weeks after carotid endarterectomy, but this may be longer if your job is very physically demanding.
Talk to your consultant about when you can expect to return to work after your carotid endarterectomy.
How soon can I drive?
You can drive when you can turn your head comfortably and perform an emergency stop. This is normally around two to three weeks after your operation. If you have had a TIA or stroke, you must not drive for a month afterwards.
When will I be back to normal?
Recovery from carotid endarterectomy is a gradual process that is different for everyone. To help your recovery go as smoothly as possible, follow your consultant's instructions carefully and call the hospital if you have any questions or concerns.
Most people are able to resume daily activities around three to four weeks after carotid endarterectomy.
As with all types of surgery, carotid endarterectomy carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision so please ask any questions you may have.
Possible complications of any surgery include:
- Bleeding
- Infection
- Blood clots
- Adverse reactions to the anaesthetic
- Chest infection
Possible complications specific to carotid endarterectomy include:
- TIA or stroke —occurs in 5% to 7% of people who have had a previous TIA or stroke and 2% to 3% of those who haven’t
- Swelling at the incision site
- Heart attack
- Cerebral haemorrhage (bleeding in the brain)
- Nerve problems affecting the eyes, nose, ears, or tongue
- Seizures (fits)
- Re-blockage of the carotid artery
We answer some of your most commonly asked questions about carotid endarterectomy.
What should I watch for after carotid endarterectomy surgery?
If you have any questions or concerns after your carotid endarterectomy, see your healthcare provider or contact your consultant for advice.
Seek immediate medical attention if you have:
- Fever (temperature above 38C)
- Redness, swelling or severe pain at your incision site
- Green, unpleasant-smelling discharge from your surgical wound
- A cough with yellow or green phlegm
- Severe headache, numbness, or weakness on one side of your face or body, difficulty understanding or speaking, confusion, difficulty walking, or problems with balance or coordination - may be signs of a stroke
- Severe pain in the centre of the chest that may radiate to the jaw or left arm, shortness of breath, weakness, light-headedness, fatigue, and nausea - may indicate a heart attack
How long does a carotid endarterectomy take?
Carotid endarterectomy normally takes around two hours.
How long is the recovery from carotid endarterectomy?
Recovery from carotid endarterectomy surgery varies from person to person, but most people are recovered by between three and four weeks after surgery.
Is carotid endarterectomy high-risk surgery?
Like any surgery, there are risks associated with carotid endarterectomy. The main risks are stroke and death. The risk of stroke is around 2%, slightly higher if you've had a previous stroke or TIA. The risk of death from stroke or heart attack is less than 1%. Your consultant will explain all the possible risks and complications of carotid endarterectomy with you before your surgery and discuss the risks and benefits of the procedure.
How big is the incision for carotid endarterectomy?
The incision made during carotid endarterectomy is around 10cm (4 inches) in length.
At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:
- Flexible appointment times and locations that are convenient for you
- The freedom to choose which hospital and consultant suit your needs
- Personalised, consultant-led treatment plans tailored to your individual needs
- Comfortable and safe private facilities maintained by expert multidisciplinary teams
- Private ensuite rooms as standard
- A range of delicious healthy meals
- Affordable, fixed-price packages with aftercare included
- Flexible payment options to help you spread the cost of your care
If you would like to see a consultant or learn more about carotid endarterectomy, book your appointment online today or call a member of our team directly.
Content reviewed by Circle in-house team in April 2023. Next review due April 2026.
- Overview: Carotid endarterectomy, NHS
- Carotid endarterectomy, John Hopkins
- Carotid endarterectomy, NIH
- Carotid artery surgery-open, Medline Plus
