Carotid endarterectomy is a surgical procedure that removes plaque from the carotid arteries in the neck to restore healthy blood flow to the brain. By relieving this narrowing, it lowers the risk of stroke for appropriately selected patients. At Cape Fear Valley, vascular and neurosurgical specialists collaborate to evaluate each case and deliver a safe, evidence-based plan of care. Our team explains when carotid endarterectomy is appropriate and how the procedure compares with other options.
Overview of Carotid Endarterectomy
Carotid artery stenosis occurs when fatty plaque builds up in one or both carotid arteries, reducing blood flow and increasing the chance of stroke. Clearing the plaque with carotid endarterectomy helps prevent clots from forming or breaking off and traveling to the brain.
Candidates often include people with symptomatic stenosis—such as a recent transient ischemic attack or minor stroke—with significant narrowing, commonly 50% to 99% on imaging. Some individuals with asymptomatic stenosis, typically 70% to 99%, may also benefit when surgical risk is low and overall health supports a durable benefit. Diagnosis is based on vascular imaging and clinical assessment of the carotid end and artery segments above and below the narrowing.
The carotid arteries run along each side of the neck and supply oxygen-rich blood to the brain. Over time, cholesterol and inflammation can cause plaque that narrows the channel. As narrowing progresses at the carotid end, blood flow becomes turbulent, clots can form, and fragments may embolize to the brain, causing stroke.
Treatment of Carotid Endarterectomy
Before surgery, most patients have a duplex ultrasound to measure the degree of narrowing and assess blood flow. Additional studies such as CT angiography (CTA) or MR angiography (MRA) further define the anatomy. A preoperative cardiac evaluation checks heart health, and medications are reviewed to optimize antiplatelet therapy, statins, and blood pressure control. Your care team will advise which medicines to take or hold before carotid endarterectomy.
During conventional carotid endarterectomy, the surgeon makes an incision along the side of the neck, opens the artery, removes the plaque, and repairs the artery, often using a patch to widen the vessel and reduce the chance of restenosis. In an eversion endarterectomy, the artery is cut, turned inside out to remove plaque, and then reattached. A temporary shunt may be used to maintain blood flow to the brain while the artery is open. Anesthesia can be general (you are asleep) or regional with local anesthesia and sedation, which allows real-time neurologic monitoring. Your surgeon will recommend the approach that best fits your needs and will explain how the endarterectomy site is reconstructed at the carotid end.
Benefits include a meaningful reduction in future stroke risk for the right candidates. Possible complications include stroke, heart attack, cranial nerve injury that can cause temporary hoarseness or tongue or facial weakness, bleeding or hematoma, and infection. These events are uncommon, and your team will review your individual risks and expected outcomes from carotid endarterectomy.
Recovery of Carotid Endarterectomy
Most patients spend one night in the hospital for neurologic checks and blood pressure monitoring. A small drain may be placed and is usually removed before discharge. Plan to avoid strenuous activity and heavy lifting for about one to two weeks, keep the incision clean and dry, and watch for swelling, redness, drainage, fever, sudden neck swelling, or any new neurologic symptoms. You will receive detailed wound care and pain management instructions after your endarterectomy.
Follow-up typically includes continuing or starting an antiplatelet medicine (such as aspirin) and a statin, along with careful blood pressure, diabetes, and cholesterol control. Heart-healthy lifestyle changes—quitting smoking, balanced nutrition, regular physical activity, and weight management—support long-term success. Surveillance with duplex ultrasound is commonly scheduled at about 1 month, 6 months, and then annually, or as advised by your surgeon.
Preparing for surgery at Cape Fear Valley includes reviewing current medicines, arranging transportation and home support, and discussing questions at your preoperative visit. Consider asking about the degree of stenosis, why carotid endarterectomy is recommended versus stenting or medical therapy alone, anesthesia options, and your personal risks and benefits. Our patient support services include preoperative education, care coordination, smoking cessation resources, cardiac risk assessment, and postoperative nurse follow-up. To learn more or schedule an evaluation, contact the Cape Fear Valley vascular surgery team.