Carotid endarterectomy

What is Carotid endarterectomy?

Carotid endarterectomy is an operation performed on narrowed carotid arteries to help reduce the risk of stroke. These arteries lie in the neck and are an important blood supply to the brain.

As you age, plaque can build up in the walls of your arteries causing them to narrow. This process is called atherosclerosis, or hardening of the arteries. If enough plaque builds up then the blood flow can be reduced through your carotid arteries and the smooth inner lining of the arteries can be damaged and ulcerated. Small clots can form on the plaque, and plaque or clots can break loose and travel to the brain.

If a clot or plaque blocks the blood flow to your brain sufficiently, it can cause an ischaemic stroke, which can cause permanent brain damage, or death, if a large enough area of the brain is affected. If a clot or plaque blocks only a tiny artery in the brain, it may cause a transient ischaemic attack (TIA), also known as a mini-stroke, which is often a warning sign that a larger stroke may occur in the near future and treatment is required.

How does it work? 

Your surgeon will make an incision on one side of your neck to expose the narrowed carotid artery and will remove the inner lining of the diseased section of your artery containing the plaque. The operation can be performed under general anaesthesia or under local anaesthesia.

What are the benefits of Carotid endarterectomy?

Carotid endarterectomy is highly beneficial for patients with recent TIAs or non-disabling strokes. In some patients with narrowed carotid arteries and no symptoms, carotid endarterectomy may also help to reduce their risk of stroke. All patients with narrowed carotid arteries should also be on best medical therapy whether they have a carotid endarterectomy or not.

This includes the use of antiplatelet drugs (such as aspirin), cholesterol-lowering drugs (such as statins), blood pressure drugs and smoking cessation. 

How safe is Carotid endarterectomy?

Carotid endarterectomy is a commonly performed operation. The principal risks are heart attack and stroke. In the majority of patients, the risk of carotid endarterectomy combined with best medical therapy is less than the risk of best medical therapy alone in patients with a narrowed carotid artery and recent TIAs or a non-disabling stroke.

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