Carotid Endarterectomy

Overview

Carotid endarterectomy is an operation to clear fatty deposits from the carotid arteries — the two main blood vessels on the sides of your neck that carry blood to your brain. Clearing this blockage helps reduce your risk of having a stroke.

Carotid endarterectomy is a common and well-established operation for people with significant narrowing of the carotid arteries. Your care team will only suggest it if the benefits are likely to outweigh any risks.

It is most often considered in adults over 60, in people who have already had a mini-stroke or stroke, or in people with severe narrowing and stroke risk factors. It is very rarely performed in children.

Symptoms

Common symptoms

• Most people with a narrowed carotid artery have no symptoms at all.
• A mini-stroke (transient ischaemic attack, or TIA) can cause temporary weakness, numbness, or difficulty speaking.
• A stroke can cause sudden face drooping, arm weakness, or speech problems.

Causes

Main causes

• The most common cause is atherosclerosis — a build-up of fatty plaque inside the artery walls.
• Less commonly, the carotid artery can tear or become damaged by injury, inflammation, or radiation to the neck.

Risk factors

• High blood pressure
• Smoking
• Diabetes
• High cholesterol
• Age over 60
• Being male
• Having a family history of stroke
• Being physically inactive

When to see a doctor

See a doctor urgently if:

• Go to an emergency department if you or someone else has sudden weakness, facial drooping, or trouble speaking.
• Also go to an emergency department if stroke-like symptoms come and go — this could be a mini-stroke (TIA) and needs urgent assessment.

Book a routine appointment if:

• Make a routine appointment if you have high blood pressure, diabetes, high cholesterol, or a strong family history of stroke and you have not had a recent check-up.
• Ask your doctor about your stroke risk if you smoke or have been told you have carotid artery narrowing.

Diagnosis

The diagnosis is usually made with a painless ultrasound scan, which looks at blood flow in the neck arteries. Your doctor may also use a stethoscope to listen for an abnormal 'whooshing' sound over the artery.

Tests that may be done

• Carotid ultrasound
• CT or MRI scan of the neck and brain
• CT angiography or MR angiography (special scans of blood vessels)
• Blood tests to check cholesterol and blood sugar

What to expect at your appointment

Your doctor will ask about your symptoms, medical history, and stroke risk. The tests are usually done as an outpatient, and you will be told what the scans show and whether surgery is an option for you.

Treatment

The main goal is to prevent a future stroke. Treatment begins with healthy lifestyle choices and medicines to control blood pressure, cholesterol, and blood clotting. If the narrowing is severe or has already caused symptoms, surgery may be recommended.

Self-care at home

• Take all prescribed medicines exactly as your doctor advises.
• Stop smoking — your health team can help you make a plan.
• Take steps to lower blood pressure and cholesterol through diet and activity.
• Learn the signs of stroke and share them with family and friends.

Medical treatments

Doctors usually prescribe medicines to lower blood pressure and cholesterol and to reduce blood clotting. They may also suggest a medicine that makes blood less sticky. Never start, stop, or change these medicines yourself — talk to your doctor and pharmacist.

When is surgery considered?

Carotid endarterectomy is most often recommended when a carotid artery is significantly narrowed, especially if you have already had a mini-stroke or stroke, or if the narrowing is severe even without symptoms. Your surgical team will discuss the risks and benefits with you.

Living with this condition

If you have surgery, you will likely stay in hospital for a day or two. Your neck may be sore and you may feel tired. This improves gradually. Your team will tell you when you can shower, drive, lift, and return to normal activities.

Lifestyle tips

• Keep a steady routine with your medicines.
• Attend follow-up appointments and neck ultrasounds.
• Check your blood pressure regularly at home if your doctor advises it.
• Get enough sleep and find healthy ways to manage stress.

Diet and exercise

Try to eat a balanced diet rich in vegetables, fruit, whole grains, and healthy proteins. Ask your doctor or a dietitian about a heart-healthy eating plan. Aim for regular movement such as walking, but follow your surgeon’s advice about returning to exercise after surgery.

Mental health and emotional wellbeing

Having a procedure on your neck or living with stroke risk can be stressful and frightening. It is normal to feel worried, low, or anxious. Talk to your doctor or specialist nurse — they can direct you to counselling or other support.

Prevention

You cannot always prevent plaques from forming, but you can lower your risk by not smoking, keeping blood pressure and cholesterol in a healthy range, managing diabetes, staying active, and following your treatment plan.

Vaccines

Vaccines do not prevent carotid artery narrowing, but staying up to date with recommended vaccines, such as flu and COVID-19 vaccines, helps prevent infections that can stress your heart and blood vessels.

Screening programmes

There is no simple screening test for everyone. Your doctor can check your blood pressure and cholesterol, and, if you have risk factors or symptoms, arrange a carotid ultrasound.

Complications

If left untreated

• If a severely narrowed carotid artery is not treated, blood flow to the brain can become blocked.
• This can lead to a transient ischaemic attack (TIA) or a stroke.
• A stroke can cause permanent weakness, difficulty speaking, vision problems, or other long-term disabilities.

Long-term outlook

Carotid endarterectomy is a safe and effective procedure for many people. It has been performed for decades, and after surgery most people can resume a normal life. Recovery takes time, but by staying with your medicines, lifestyle changes, and follow-up care, your risk of stroke is greatly reduced.

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