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Carotid Endarterectomy
Carotid Endarterectomy is a vascular surgical procedure that removes the atherosclerotic plaque from a narrowed carotid artery in the neck — dramatically reducing the risk of stroke and TIA by restoring smooth, unobstructed blood flow to the brain.
Overview
Carotid Endarterectomy removes the dangerous atherosclerotic plaque that has built up in the internal carotid artery and is responsible for the majority of significant strokes — either through embolisation of plaque fragments to the brain or through critical reduction in carotid blood flow. The procedure is performed through a neck incision, the carotid artery is carefully clamped and opened, the plaque is meticulously removed under direct vision, and the artery is closed with a patch to create a wide, smooth lumen. Carotid endarterectomy reduces the risk of ipsilateral stroke by over 50% in symptomatic patients with 70 to 99% stenosis compared to medical management alone — one of the most proven stroke prevention interventions in vascular surgery.
Types of Carotid Endarterectomy
CEA has established and emerging technical variants, with patch closure and regional anaesthesia allowing awake neurological monitoring being the most evidence-supported approaches.
- Standard CEA with Patch Angioplasty (vein or synthetic patch closure — reduces re-stenosis risk)
- CEA under Regional (Awake) Anaesthesia (continuous neurological assessment during clamping)
- CEA under General Anaesthesia with Neuromonitoring (SSEPs or TCD monitoring)
- Eversion Carotid Endarterectomy (circumferential ICA eversion technique)
- Carotid Artery Stenting (CAS — endovascular alternative for high surgical risk patients)
Risk Factors for Carotid Artery Disease
Carotid atherosclerosis develops through the same mechanisms as coronary artery disease and shares the same modifiable and non-modifiable risk factors.
- Smoking — the most powerful modifiable risk factor for carotid plaque development and progression
- Hypertension causing shear stress and endothelial damage at the carotid bifurcation
- Hyperlipidaemia promoting atherosclerotic plaque accumulation in the carotid bulb
- Diabetes accelerating carotid atherosclerosis and plaque vulnerability
- Advanced age — carotid stenosis prevalence increases significantly above age 65
- Male sex — higher carotid disease burden in men, though women have higher stroke risk per stenosis degree
Carotid Stenosis Symptoms
These symptoms indicate significant carotid artery disease requiring urgent Doppler ultrasound and specialist vascular surgery assessment.
- TIA — transient ischaemic attack — brief focal neurological deficit lasting less than 24 hours
- Minor stroke with partial recovery indicating an embolic event from the carotid plaque
- Amaurosis fugax — sudden transient monocular visual loss like a curtain descending
- Contralateral arm or leg weakness or sensory disturbance
- Speech disturbance — dysphasia or dysarthria from dominant hemisphere ischaemia
- Carotid bruit on auscultation in the neck (not always present)
- Incidental high-grade stenosis on Doppler ultrasound in an asymptomatic patient
- Duplex confirming 70 to 99% stenosis in a symptomatic patient — threshold for urgent CEA
Key Benefits
Discover the advantages of choosing our carotid endarterectomy services.
Reduces stroke risk by over 50% compared to medical management alone for symptomatic disease
Permanent plaque removal eliminates the embolic source responsible for TIA and minor stroke
Patch angioplasty closure provides the widest possible carotid lumen for long-term patency
Operation ideally within 2 weeks of TIA provides maximum stroke prevention benefit
Specialist vascular surgical team with dedicated carotid surgery expertise and audit outcomes
Clinical Features
The technology, techniques and clinical approach behind our carotid endarterectomy.
Awake regional anaesthesia with continuous neurological monitoring during carotid clamping
Shunt immediately available and inserted if any neurological change during clamping
Correct endarterectomy plane meticulously maintained preserving arterial wall integrity
Vein or synthetic patch closure reduces long-term re-stenosis rate compared to primary closure
Doppler flow confirmation after clamp release before wound closure
Preparation Instructions
After Carotid Endarterectomy, take all prescribed antiplatelet medications without missing a single dose — aspirin is lifelong and must never be stopped without cardiology or vascular surgery advice. Attend Duplex surveillance at 6 weeks, 6 months, and annually to monitor for re-stenosis. Actively manage all cardiovascular risk factors: stop smoking permanently, achieve target blood pressure below 130/80, and reach LDL cholesterol below 1.8 mmol/L. Contact your vascular surgery team or call emergency services immediately for any sudden neurological symptoms — weakness, speech difficulty, or visual change — after the operation.
The Procedure
Step-by-step guide to what you can expect during your carotid endarterectomy procedure.
Pre-Operative Carotid Imaging Review
Your vascular surgeon reviews the carotid duplex ultrasound, CT angiogram, and MRI brain to confirm the degree of stenosis, the plaque morphology, the intracranial anatomy, and the timing of the most recent TIA or stroke — confirming CEA is indicated and safe.
Regional Cervical Block or General Anaesthesia
Awake CEA under cervical plexus block allows continuous neurological monitoring during carotid clamping — if the patient develops any new neurological deficit a shunt is immediately inserted. General anaesthesia with TCD or SSEP monitoring is used when regional anaesthesia is not appropriate.
Carotid Artery Exposure Through Neck Incision
A longitudinal or oblique neck incision exposes the carotid bifurcation. The common, internal, and external carotid arteries are dissected free, vessel loops applied, and all small branches identified and controlled before any vessel is clamped.
Carotid Clamping and Shunt Assessment
The carotid arteries are sequentially clamped and, under awake monitoring or cerebral perfusion assessment, a shunt is inserted if needed to maintain cerebral blood flow during the endarterectomy. Most patients do not require a shunt.
Plaque Endarterectomy Under Direct Vision
A longitudinal arteriotomy is made and the atheromatous plaque is carefully dissected from the carotid arterial wall — separating the plaque along the correct medial plane until all disease is removed and the remaining arterial wall is smooth and feather-edged.
Patch Angioplasty Closure and Flow Confirmation
A vein or synthetic patch is sutured along the arteriotomy to close the carotid with a wider lumen and lower re-stenosis rate than primary closure. Flow is restored with sequential clamp release and Doppler confirms brisk flow before wound closure.
What to Expect
Carotid Endarterectomy is performed under general or regional (cervical block) anaesthesia and takes 1.5 to 2 hours. The carotid artery is exposed through a neck incision, clamped under cerebral protection with a shunt if needed, opened longitudinally, and the plaque is carefully removed from the vessel wall under direct vision. A patch is sutured into the artery to close it widely and prevent re-stenosis. Most patients are discharged within 24 to 48 hours.
Frequently Asked Questions
Common questions about carotid endarterectomy.
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