What is carotid endarterectomy?
endarterectomy is surgery to remove plaque from one or both carotid
During a carotid endarterectomy:
- A 4- to 5-inch incision is made in the neck
just below the level of the jaw, exposing the narrowed carotid
- The blood flow through the narrowed area may need to be
temporarily rerouted (shunted). Rerouting is done by placing a tube in the
vessel above and below the narrowing. Blood flows around the narrowed area
during the surgery.
- The artery is opened and the plaque is
carefully removed, often in one piece.
- A vein from the leg may be
sewn (grafted) on the carotid artery to widen or repair the
- The shunt is removed, and the artery and skin incisions are
What kinds of tests are needed before considering surgery?
Tests such as a
carotid arteriogram, or
magnetic resonance angiogram (MRA) are needed before
considering surgery. These tests allow your doctor to measure the plaque
buildup in your carotid arteries and see how well blood flows through the
narrowed area. The amount of narrowing (stenosis) usually is described as a
percentage. For example, if a plaque is blocking half of the artery, the doctor
may say the artery is 50% narrowed. If plaque is blocking three-quarters of the
artery, the doctor may say the artery is 75% narrowed.
these tests can also check the blood vessels above and below the neck. If those
vessels are blocked or damaged, surgery may not be helpful because the surgeon
cannot easily operate on these areas.
No test can predict
accurately which plaques are likely to cause a blood clot to form and cause a
TIA or stroke. But experts believe that irregular, jagged, or unstable plaques
are more likely than smooth plaques to cause problems. A person who has a
narrowed carotid artery that contains an irregular or jagged plaque may be at
greater risk for a stroke or TIA and may benefit more from surgery.
What are the risks of carotid endarterectomy?
Risks of surgery depend on your age, your overall health, and the skill
and experience of the surgeon.
The major risks associated with
carotid endarterectomy are:
- Heart attack. Most
deaths that occur during a carotid endarterectomy are caused by a heart attack
- Heart and breathing
difficulties, high blood pressure, infection, injury to nerves (usually causing
vocal cord paralysis and problems with managing saliva and tongue movement),
and bleeding within the brain.
- Plaque buildup, which may redevelop
as a late complication between 5 months and 13 years after surgery.
Who should not have carotid endarterectomy?
experts agree that carotid endarterectomy is not recommended for people who
- TIAs that are occurring because of narrowed
blood vessels in the back of the brain (vertebrobasilar
- Significant disease of the arteries supplying the heart
(coronary arteries) or uncontrolled high blood pressure.
hardening of the arteries (atherosclerosis) that reduces blood flow in the
vessels that branch off from the carotid arteries.
- Other serious
medical problems, such as kidney failure or
heart failure, that would make surgery more
Are other treatments available?
Carotid artery stenting is a procedure similar to one
commonly used to open narrowed arteries in the heart. Angioplasty combined with
stent is now being done as an alternative to surgery
for preventing TIA or stroke. In this procedure, a catheter is threaded through
an artery in the groin and passed up to the carotid arteries. A tiny balloon is
used to enlarge the narrowed portion of the artery, and a wire mesh stent is
used to keep the artery open.
Carotid artery stenting may be as
effective as carotid endarterectomy in preventing stroke, heart attack, and
other complications in some people who have narrowed carotid arteries.2, 3, 4 Talk to
your doctor if you would like to know if carotid artery stenting is a good
option for you.
If you need more information, see the topic