Overview

The carotid arteries carry blood to your head, brain and face. When plaque builds up it causes blockages in these arteries. These blockages could lead to a stroke or a transient ischemic attack (TIA, or mini-stroke). A carotid endarterectomy is the surgical removal of this plaque.

A carotid endarterectomy can be carried out under local anaesthetic (you are awake) or general anaesthetic (you are asleep).

You can read more about having an anaesthetic.

You will have a scar running vertically down your neck. It will run from near the angle of your jaw or ear lobe towards your breastbone. The cut (incision) is usually 7 to 10cm long.

Benefits of having a carotid endarterectomy

When blood flow to the brain is reduced, a small piece of debris can dislodge and travel to the brain or the eye causing a TIA. This can temporarily affect the function of your brain. Or it may cause a stroke, which is permanent loss of brain function. 

The aim of a carotid endarterectomy is to prevent you from having a stroke or TIA, by reducing the risk of debris dislodging from the plaque.

Symptoms of a stroke can include: 

• numbness or weakness in the face, arm, or leg, especially on one side of the body
• confusion or difficulty in talking or understanding speech
• trouble seeing in one or both eyes

You may experience some of these symptoms with a TIA, but they might only last a few minutes.

If surgery has been recommended for you, this is because the narrowing of the carotid artery responsible for your TIA or stroke is already significant. Usually the operation will be performed if the narrowing is more than half (50%) of the artery. Your risk of stroke varies according to the symptoms and scan results.

Risks of having a carotid endarterectomy

As with any operation, there is a risk of you having a medical complication. Your doctor will go through all the risks with you before you sign your consent form. The more common surgical risks include:

Stroke

A small number of people (1 to 3 in 100) having carotid endarterectomy may have a stroke during or immediately after the operation. A stroke can range from being very mild (causing little or no disability), through to being severe (causing major disability or death). All possible precautions will be taken to prevent this. 

The risk of having a stroke related to the surgery is less than the risk of not having surgery to treat the narrowing in the artery. 

Nerve injury

There is a small risk of nerve injury from the surgery. Skin nerves may be injured when the cut is made and can lead to loss of sensation to a small area on the side of your neck. This may recover with time or it may be permanent. If this does happen, care must be taken when shaving. Some people can also experience pain or numbness around the ear and back of the head.

Nerve damage

Damage to the nerves nearer to the carotid artery can cause a temporary loss of function. Sometimes this can be permanent but that is very rare. 

• The vagus nerve helps control your voice box, so can lead to a hoarseness of voice after the operation. 
• The hypoglossal nerve helps control the muscles of the tongue, which can affect swallowing by reducing the tongue’s mobility. 
• The facial nerve helps control the muscles of the face, damage to it can affect movement of muscles around the neck and jaw.

Infection

There is a future risk of infection of the patch that is used to repair the artery.

Heart attack

There is a small risk of heart attack related to the anaesthetic.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the operation, you will be asked to sign a consent form. This states that you understand what is involved and agree to have the treatment. 

Read more about our consent process.

Having surgery

Pre-assessment

You may be asked to attend a pre-assessment appointment before your surgery. A doctor or nurse will assess your fitness to have the surgery. We will review your regular medicines at this appointment. 

Medicines

If you are taking any antiplatelet medicines (such as aspirin or clopidogrel) you will not be asked to stop them. 

Other anticoagulant medicines that reduce the blood’s ability to clot (such as warfarin, rivaroxaban, apixaban), must be stopped temporarily before surgery. This may require you to have blood thinning injections while off your medication. 

If you are taking any medicines for diabetes (for example, metformin) or using insulin, the dose may need to be altered or temporarily stopped near the time of the procedure. 

Please let us know if you are taking any regular medicines, including any herbal or homeopathic medicines you buy in a shop or pharmacy.

Also let us know if you have any allergies to any medicines.

You will be given full information on any changes that you need to make to your medicines at the pre-assessment appointment. Please ask us if you have any questions. 

Stopping food and drink before surgery (fasting)

We will give you information about fasting, which is usually for 6 hours before surgery. Fasting means that you cannot eat or drink anything (except water). We will give you clear instructions on whether you need to fast and when to start fasting. It is important to follow these instructions. If there is food or liquid in your stomach during the operation, it could come up to the back of your throat and damage your lungs. 

You can take your regular morning medicines with a sip of water before 6am on the morning of the procedure, unless you have been told otherwise.

If you continue to eat or drink after this, your surgery will be cancelled.

On the day of your surgery

An anaesthetist will speak to you before your surgery to ask about your health and explain the different ways in which pain can be prevented and controlled after your surgery. 

In the anaesthetic room, you will be asked to lie on a trolley and you will be attached to a heart monitor, and a cuff placed on your arm to monitor your blood pressure. 

If you are having a general anaesthetic, the anaesthetist will put a cannula (thin tube) into a blood vessel to give you the medication to put you to sleep. The anaesthetist will stay with you and monitor you during your surgery. 

Read our information about having an anaesthetic.

During the surgery

Once the neck is opened, the branches of the artery are clamped. A shunt (tube) might be used to bypass the clamped arteries during the surgery. This is not always needed as the other arteries to the brain can ‘cross-cover’ the blood flow very effectively. 

The artery is opened and the plaque causing the narrowing is removed. When the inside of the artery has been cleared, it is closed with very fine stitches. Sometimes a patch will be stitched to the artery to prevent further narrowing.

The wound is usually closed with a dissolvable stitch under the skin. Your surgeon will place a small plastic drain in your neck to drain any blood and to reduce neck swelling after the operation. This will normally be removed the next day,

Pain

If you have a general anaesthetic you will be asleep during the operation. 

If you have local anaesthetic and start to feel uncomfortable, please let the surgeon know and they will give you more local anaesthetic. You will also be given some sedation, and you may not be very aware of the operation at all. 

You may feel some pain and discomfort in your neck after the operation. The nurses on the ward will be able to give you painkillers to help with this.

After surgery

You will wake up in the recovery area, where you will be monitored until you are ready to be moved to a ward. This may not be the same ward that you were admitted to.

On the ward, we will continue to monitor you, such as checking your blood pressure and pulse. We will also monitor your neurological functions (such as arm, leg and facial movements). 

After this type of operation you are unlikely to feel sick, so you should be able to eat and drink again within a few hours. You may experience some temporary swallowing difficulties due to the surgery. 

The next day you will have blood tests and the drain will be removed.

Most people can go home in the afternoon after assessment by the physiotherapy team. You may need to stay another night, depending on how you feel and your social circumstances. 

There is often some swelling and bruising in the neck, but this settles in 7 to 10 days. 

The cut on your neck will be quite visible at first, but will become almost invisible within 2 to 3 months.

Leaving hospital

You may feel tired for several weeks after the operation. Get plenty of rest and slowly start to build up your regularly activities. 

Stitches

The stitches to the wound are normally dissolvable so will not need to be removed. 

We may give you a letter to take to the practice nurse at your GP surgery, for a wound review 2 to 3 days after you leave hospital. If you cannot travel to your GP surgery we may refer you to a district nurse.

Bathing

You can shower as soon as your wound is dry. We advise to wait for 2 weeks before having a bath due to the dissolvable stitches. 

Exercise

Regular exercise, such as a short walk, combined with rest is recommended to provide a gradual return to normal activity.

Avoid strenuous exercise and activity for about 6 weeks. 

Sex

You can resume a normal sex life after 2 to 3 weeks if you feel happy to do this.

Driving

You will be safe to drive when you can move your neck freely to allow a good view of the road, especially behind you. This will normally be after 4 to 6 weeks. You should avoid driving long distances and on motorways at first. 

If you have had a recent stroke or TIA, then you are not allowed to drive for 4 weeks. You do not need to tell the DVLA. After 1 month you may be able to drive again, as long as your doctor agrees it is safe for you to do so. 

If you are not sure, ask your GP or your surgeon at your follow-up appointment.

Returning to work

If you work you should be able to resume your job in 1 to 3 months. If you are unsure, check with your doctor. 

Medicines

You will usually need an antiplatelet medicine to help reduce the stickiness of your blood and reduce the risk of a further stroke. The surgical team will tell you which antiplatelet they have prescribed and you will need to take this medicine for the rest of your life. 

You will also need to take a statin for the rest of your life. This medicine helps to lower blood cholesterol levels and further build up in your arteries. 

We will give you a prescription for these medicines if you were not already taking them, and will ask your GP to continue this prescription for you.

Follow-up appointment

After you have left hospital, you will receive an appointment to see your surgeon 6 to 8 weeks later. This will be organised in your local hospital where possible. 

To make sure everyone you meet always has the most up-to-date information about your health, we may share information about you between the hospitals.