This surgery is done to restore normal blood flow to the brain to prevent a stroke if you already have symptoms of reduced blood flow. Carotid endarterectomy also may be performed preventively if a diagnostic test such as carotid ultrasound shows significant blockage that is likely to trigger a stroke. Carotid endarterectomy is not a cure. Your arteries can become blocked again if your underlying condition, such as high blood cholesterol, is not controlled and causes new plaque buildup.

Carotid endarterectomy is done in a hospital. You may have general anesthesia and will not be awake or feel pain during the surgery. Your surgeon instead may decide to use local anesthesia to numb only the part of your body being worked on so that he or she can check your brain’s reaction to the decreased blood flow during surgery. You also will be given medicine to relax you during the surgery. Your vital signs will be monitored during surgery. You will lie on your back on an operating table with your head turned to one side. Your surgeon will make an incision, or cut, on your neck to expose the blocked section of the carotid artery. Your surgeon will cut into the affected artery and remove the plaque through this cut. A temporary flexible tube may be inserted so blood can flow around the blocked area as the plaque is cleared. After removing the plaque from your artery, the surgeon will close the artery and neck incisions with stitches.

After surgery, you will recover in the hospital for one to two days. Your neck may hurt for a few days, and you may find it hard to swallow. Your doctor may prescribe medicine to prevent clots and suggest steps to keep your carotid arteries healthy.

Carotid endarterectomy is fairly safe when performed by experienced surgeons. However, serious complications such as clotting, stroke, or death may occur. Taking anticlotting medicines before and after surgery can reduce this risk. Other complications may include a reaction to anesthesia, short-term nerve injury that causes temporary numbness in your face or tongue, bleeding, infection, high blood pressure, heart attack, and seizure. The risk of complications is higher in women, older people, those with certain conditions such as chronic kidney disease or diabetes, and those with other serious medical conditions.

Your doctor may recommend carotid endarterectomy (CEA) if you have carotid artery disease. CEA can help prevent strokes in people who have this disease.

CEA is most helpful for people who have carotid artery disease and one or more of the following:

• A prior stroke.
• A prior transient ischemic attack (TIA), also called a "mini-stroke." During a TIA, you may have some or all of the symptoms of a stroke. However, the symptoms usually last less than 1-2 hours (although they may last up to 24 hours).
• Severely blocked carotid arteries (even if you don't have stroke symptoms).

Other Treatments for Carotid Artery Disease

Anticlotting medicines, such as aspirin and clopidogrel, also are used to treat people who have carotid artery disease. These medicines help reduce blood clotting and lower the risk of stroke.

A procedure called carotid angioplasty may be used instead of CEA to treat blocked carotid arteries. For this procedure, a thin tube with a balloon on the end is threaded to the narrowed or blocked carotid artery.

Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. Usually, the doctor then places a small metal stent (tube) in the artery. The stent reduces the risk that the artery will become blocked again.

Your doctor will tell you how to prepare for carotid endarterectomy (CEA). Before CEA, you may have one or more tests to examine your carotid arteries. These tests can show whether your arteries are narrowed and how much they're narrowed.

Carotid Ultrasound

Carotid ultrasound is a painless and harmless test that uses sound waves to create pictures of the insides of your carotid arteries.

A carotid ultrasound test may include a Doppler ultrasound study. Doppler ultrasound shows the speed and direction of blood flow through your blood vessels.

Carotid Angiography

Carotid angiography is a special type of x ray. For this test, a small tube called a catheter is put into an artery, usually in the groin (upper thigh). The tube is then moved into one of your carotid arteries.

A substance called contrast dye is injected into the carotid artery. This dye outlines the artery and any blockages on the x-ray pictures.

Magnetic Resonance Angiography

Magnetic resonance angiography (MRA) is a test that creates pictures of your carotid arteries using a large magnet and radio waves. Your doctor can see these pictures on a computer screen.

Contrast dye may be used during MRA. The dye makes your arteries show up better on the pictures. (The contrast dye used for MRAs is different from the contrast dye used for x-ray tests.)

Computed Tomography Angiography

Computed tomography (to-MOG-rah-fee) angiography, or CT angiography, is a test that uses x rays to take pictures of your body from many angles. A computer combines the pictures into two- and three-dimensional images.

Contrast dye may be used during CT angiography. The dye makes your arteries show up better on the pictures.

Carotid endarterectomy (CEA) is done in a hospital. The surgery usually takes about 2 hours.

You will have anesthesia (AN-es-THE-ze-ah) during the surgery so you don't feel pain. The term "anesthesia" refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep. Local anesthesia numbs only certain areas of your body.

Your surgeon may choose to give you local anesthesia so he or she can talk to you during the surgery. This allows the surgeon to check your brain's reaction to the decrease in blood flow that occurs during the surgery.

During CEA, your surgeon will make an incision (cut) in your neck to expose the blocked section of the carotid artery. He or she will put a clamp on your artery to stop blood from flowing through it.

During the procedure, your brain gets blood from the carotid artery on the other side of your neck. However, your surgeon also may use a tube called a shunt to move blood around the narrowed or blocked carotid artery.

Next, your surgeon will make a cut in the blocked part of the artery. To remove the plaque, he or she will remove the inner lining of the artery around the blockage.

Finally, your surgeon will close the artery with stitches and stop any bleeding. He or she will then close the incision in your neck.

If you have small arteries or have already had a CEA, your surgeon might place a patch over the cut in the artery before closing the incision in your neck. The patch may reduce the risk of stroke for some patients.

Some surgeons use another technique called eversion carotid endarterectomy. For this surgery, one of the branches of the carotid artery is cut and turned inside out. The plaque is then cleaned out and the artery is reattached.

After carotid endarterectomy (CEA), you may stay in the hospital for 1 to 2 days. This allows you to safely recover from the procedure.

If your surgery takes place early in the day and you're doing well, you may be able to go home the same day.

Recovery

For a few days after the surgery, your neck may hurt. You also may find it hard to swallow. Your doctor may advise you to eat soft foods that are easy to swallow until your neck isn't as sore. Your doctor may prescribe medicine to help control any pain or discomfort.

Talk with your doctor about when it's safe for you to go back to your normal activities after having CEA.

Ongoing Care

After CEA, ongoing care and treatment are important. Discuss your treatment needs with your doctor. Ask him or her when you should schedule followup visits.

Talk with your doctor about when to seek emergency care. Problems that require urgent care may include severe headaches and swelling in the neck. Signs or symptoms that suggest a stroke or transient ischemic attack (TIA, or "mini-stroke") also require urgent care. These signs and symptoms may include:

• Numbness or weakness of the face, arms, or legs, especially on one side of the body
• Confusion and trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Dizziness, trouble walking, loss of balance or coordination, and unexplained falls
• Severe headache with no clear cause

Let your doctor know if you have questions about any of your medicines or how to take them. After CEA, your doctor may prescribe anticlotting medicines, such as low-dose aspirin and clopidogrel. These medicines help prevent blood clots from forming or getting larger.

As part of your long-term treatment, you can take steps to keep your carotid arteries healthy. One important step is to not smoke. Smoking increases the risk of carotid artery disease and stroke. If you smoke, ask your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.

Follow your treatment plan for high blood pressure and high blood cholesterol. This can help prevent plaque buildup and blood clots in your carotid arteries.

Some people need a second CEA due to repeat plaque buildup. Following your treatment plan can help lower your chance of needing a second CEA; it also can reduce your risk of stroke.

Carotid endarterectomy (CEA) is fairly safe when done by surgeons who have experience with it. However, serious complications, such as stroke and death, can occur.

CEA also can cause less serious complications. For example, you may have a bad reaction to the anesthesia, bleeding, or infection. Short-term nerve injury may cause numbness in your face or tongue.

Certain factors may raise your risk of having CEA complications. For example, women are at higher risk of complications than men. Other risk factors include having diabetes or other serious medical conditions. People who are older than 75 and have other risk factors also are at higher risk.

Talk with your doctor about the risks of CEA. He or she can help you decide whether the surgery may benefit you.