16849 Carotid Endarterectomy

Overview

A carotid endarterectomy is an operation to remove fatty build-up (called plaque) from one of the two carotid arteries. These arteries run up each side of your neck and supply blood to the brain. When plaque collects inside them, the channel for blood gets narrower — doctors call this carotid artery disease or carotid stenosis. Clearing the plaque widens the artery again, which lowers the chance of a stroke. The operation is done by a vascular surgeon, usually with you asleep, and most people go home within a few days.

Yes. Carotid endarterectomy is a well-established and fairly common operation worldwide. It has been done safely for many decades and is one of the standard treatments for narrowed carotid arteries.

It is most often done for people in their 60s, 70s and older who have narrowing of a carotid artery. It is more likely if you smoke, have high blood pressure, high cholesterol or diabetes, or have narrowed arteries elsewhere in the body. It is uncommon in younger adults and very rare in children.

Symptoms

Common symptoms

• Often there are no symptoms at all — the narrowing is found during a check-up or after a scan done for another reason.
• A brief warning episode (a 'mini-stroke' or TIA) can cause sudden weakness or numbness in the face, arm or leg on one side.
• Sudden slurred or muddled speech, or trouble finding words, that then improves.
• Sudden loss or blurring of vision in one eye, like a curtain coming down, often lasting only minutes.
• A 'whooshing' or rushing sound in the ear on the same side, or a sound your doctor hears through a stethoscope on your neck.

Symptoms in children

• Carotid narrowing is very rare in children.
• When it does happen, it is usually linked to another health condition, such as previous radiotherapy to the neck, a genetic condition affecting blood vessels, or a previous injury to the neck.
• Children are looked after by a specialist team, and any warning signs such as sudden weakness or speech changes need emergency assessment straight away.

Symptoms in older adults

• Narrowing is more common with age, especially alongside high blood pressure, high cholesterol, diabetes or smoking.
• Warning episodes (TIAs) can be mistaken for dizziness, confusion or tiredness, so they may be missed.
• Some people notice a brief episode of weakness, clumsiness or difficulty speaking that settles within an hour — this still needs urgent medical review.
• Carotid narrowing often sits alongside narrowed arteries in the heart or legs, so your doctor may check your general blood vessel health.

Causes

Main causes

• Atherosclerosis — a build-up of fatty plaque inside the artery wall, which makes the channel narrower and stiffer
• A blood clot forming on top of the plaque and partly blocking the artery
• Less often, scarring from radiotherapy to the neck, a tear in the artery wall (dissection), or an inherited condition affecting blood vessels

Risk factors

• Smoking or using tobacco in any form
• High blood pressure
• High cholesterol or other blood fats
• Type 2 diabetes
• Being older, especially over 65
• A family history of stroke or heart disease
• Carrying extra weight around the middle, and being physically inactive
• Eating a diet high in salt and saturated fat, and drinking too much alcohol
• Narrowed arteries elsewhere, such as in the heart or legs, or a previous mini-stroke

When to see a doctor

See a doctor urgently if:

• Any sudden weakness, numbness, speech change or vision loss — even if it goes away within minutes, treat it as urgent and get seen the same day
• If symptoms are happening right now, call your local emergency number immediately rather than waiting to see a doctor
• A whooshing sound in your neck or ear that has just started, or sudden neck swelling or pain

Book a routine appointment if:

• You have been told you have a narrowed carotid artery and want to talk through treatment choices
• You have high blood pressure, diabetes or high cholesterol and want a check-up
• You have a family history of stroke or blood vessel disease
• You are due a review of your heart and circulation health

Diagnosis

Doctors usually start by talking with you about any warning episodes and checking your neck and pulse. Listening to your neck with a stethoscope may reveal a rushing sound called a bruit (said 'broo-ee'). The main test is an ultrasound scan of the neck arteries, which uses sound waves to show how narrow the artery is and how fast the blood is flowing. If the scan shows narrowing, or if surgery is being considered, you may have a more detailed scan of the blood vessels in your head and neck.

Tests that may be done

• Neck ultrasound (duplex scan) — a painless scan that shows the width of the artery and blood flow
• CT angiogram — a scan using dye (contrast) to build detailed pictures of the arteries
• MR angiogram — a magnetic scan that shows the arteries without X-rays
• Blood tests for cholesterol, blood sugar and kidney function
• An ECG (heart tracing) and possibly a heart ultrasound, since heart and neck artery disease often go together
• A brain scan (CT or MRI) if you have had stroke-like symptoms

What to expect at your appointment

The tests are mostly quick and painless. An ultrasound takes around 20 to 30 minutes, and you simply lie back while a probe is moved over your neck. Scans with dye involve a small needle in your arm, and you may feel warm for a moment. You will usually be told the results by a specialist, often within a few weeks. If you have had warning symptoms, the assessment is treated as urgent so that any treatment can be planned quickly.

Treatment

Treatment aims to keep blood flowing to your brain and lower your stroke risk. It has three parts: healthy daily habits, medicines to protect your blood vessels, and for some people an operation or a stent to widen the narrowed artery. The right mix depends on how narrow your artery is, whether you have had symptoms, your other health conditions and your own preferences.

Self-care at home

• Stop smoking — this is the single biggest step you can take; ask your doctor or pharmacist for support to quit
• Take any prescribed medicines regularly and keep repeat prescriptions up to date
• Check your blood pressure at home if your team asks you to, and write down the readings
• Stay active — regular walking, swimming or cycling helps your circulation
• Eat more vegetables, fruit, wholegrains, beans and fish, and cut down on salt and fried or processed food
• Keep alcohol within recommended limits and aim for a healthy weight
• Go to your follow-up appointments, even when you feel well

Medical treatments

Doctors commonly prescribe medicines that lower blood pressure, reduce cholesterol, and make blood clots less likely (often a low-dose blood-thinning tablet). Some people are also given medicines for diabetes. These are chosen for you as an individual, so your doctor or pharmacist will explain what each one is for, how to take it and what side effects to watch for. Never start, stop or change a medicine without checking with your healthcare team. Alongside medicine, a structured healthy-living programme can make a real difference.

When is surgery considered?

Surgery is usually considered when a scan shows a significant narrowing of the carotid artery and you have had a warning mini-stroke or a stroke in the last few months. It is most effective when done soon after symptoms appear — often within two weeks — so urgent assessment matters. Surgery may also be discussed for a very narrow artery without symptoms, depending on your age, health and preferences. An alternative for some people is a carotid stent, where a small mesh tube is placed inside the artery, usually through a needle in the groin or arm. Your specialist team will explain the benefits and risks of each option for you.

Living with this condition

Most people are up and about within a day or two of surgery. You will have a small scar on your neck, and it is common to feel tender, to have a slightly sore throat or a numb patch of skin near the scar, and to feel tired for a week or two. These usually settle. You may be advised to avoid heavy lifting, straining or driving for a short time — ask your team for clear guidance. A follow-up appointment, often with an ultrasound scan, checks that the artery has healed well.

Lifestyle tips

• Keep taking your medicines and ask your pharmacist before starting any new remedy, including herbal ones
• Build gentle activity back up over the first few weeks, then aim for something active most days
• Avoid smoking and second-hand smoke
• Watch your salt intake and keep an eye on your blood pressure
• Look after your general health — regular eye, dental and diabetes checks all help your blood vessels
• Tell any doctor or dentist treating you that you have had carotid surgery

Diet and exercise

A heart-friendly eating pattern helps protect your arteries: plenty of vegetables and fruit, wholegrains, beans and lentils, nuts, olive or rapeseed oil, and oily fish once or twice a week. Cut back on salt, sugary drinks, pastries, and processed or fatty meats. For activity, aim for about 150 minutes a week of something that makes you slightly warm and breathless — a brisk walk, cycling, swimming or dancing all count. Build up slowly after surgery and follow your team's advice about the first few weeks. Strength and balance exercise twice a week is a good addition as you recover.

Mental health and emotional wellbeing

It is very normal to feel anxious before and after this kind of operation. Many people worry about having a stroke, about the scar, or about whether they will feel like themselves again. Some people find their sleep and mood dip for a while. These feelings usually ease as recovery goes on, but if worry, low mood or panic is affecting your daily life, please tell your doctor — talking therapies and other support are available and can help a great deal.

Prevention

You cannot change your age or your family history, but you can greatly lower your risk of carotid narrowing and stroke. Not smoking, keeping blood pressure and cholesterol in a healthy range, staying active, eating well and keeping to a healthy weight all protect your arteries. If you already have narrowing, these steps plus your prescribed medicines give you the best protection.

Vaccines

There is no vaccine for carotid artery disease. Keeping up with routine vaccinations — including flu and pneumonia vaccines if your doctor advises them — helps you stay well, since infections can strain your heart and circulation.

Screening programmes

There is no general screening programme for carotid narrowing in most countries, and routine scanning of people without symptoms is not usually recommended. If you have had a mini-stroke or stroke, or have narrowed arteries elsewhere, your doctor may arrange a neck ultrasound. If you have a strong family history or other blood vessel disease, ask your doctor whether a check is worthwhile.

Complications

If left untreated

• The narrowed artery can become blocked or a clot can form and travel to the brain, causing a stroke
• Warning mini-strokes (TIAs) can keep happening and may lead to a full stroke
• Stroke can cause lasting weakness, speech problems, memory difficulties or, in serious cases, be life-threatening
• Narrowing can slowly get worse over time, especially if smoking and blood pressure are not addressed

Long-term outlook

The outlook is generally good. Carotid endarterectomy is one of the best-studied operations in medicine, and when it is recommended and done promptly it substantially reduces the chance of a stroke. There are risks, including a small chance of stroke or nerve irritation during or after surgery, and your surgeon will talk these through with you honestly. Most people recover well, return to normal life within a few weeks, and feel reassured by having taken a big step to protect their future health. Keeping up with medicines and healthy habits is what makes that protection last.

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