Carotid endarterectomy

Carotid endarterectomy is an operation to remove the inner lining of the carotid artery (a blood vessel in the neck). This may be necessary if the artery has become thickened or damaged, causing a narrowed area. If left untreated, a blood clot can form in the narrowed area which can cause:

• a stroke - where the blood supply to the brain is disturbed, and brain cells begin to die, leading to brain damage, or death, or
• a transient ischaemic attack (TIA) (‘mini-stroke’) - which is similar to a stroke, but the signs and symptoms are temporary and usually disappear within 24 hours.

Carotid arteries

There are two carotid arteries, one on each side of the neck. They start at the aorta (the body’s largest artery) in the chest, and enter the base of the skull. They provide the main blood supply to the brain.

Normal, healthy arteries are elastic and smooth on the inside, so that blood can easily flow through them. As people age, plaque can build up inside arteries, making them narrower and stiffer. This process is called atherosclerosis.

Atherosclerosis

The plaque that causes atherosclerosis is made up of several substances including:

• cholesterol (a fatty substance),
• calcium, and
• fibrous tissue.

As well as aging, several other factors can contribute to a build up of plaque including:

• a diet high in fatty foods,
• hypertension (high blood pressure),
• diabetes (a long term condition caused by too much glucose in the blood), and
• smoking.

Carotid artery disease occurs when there is a build up and hardening of plaque in the carotid arteries. If the arteries are over 70% blocked, a carotid endarterectomy is usually recommended.

Carotid endarterectomy

Every year in the UK, approximately 110,000 people will have a stroke. The narrowing of the carotid artery (carotid stenosis) is responsible for about 20% of these cases.

Carotid endarterectomy is the standard treatment for carotid stenosis and can reduce the risk of future strokes. In people who have already had a stroke, or TIA, their risk of having another stroke within the next three years is reduced by a third after surgery.  

The surgery does have some risks; around 5% of people will have a stroke during the operation. However, as the risk of having a stroke during surgery is lower than the risk of having a stroke without surgery, a carotid endarterectomy is usually the recommended treatment option.

Carotid artery
You have two carotid arteries in your neck. These provide the main blood supply to the brain.

Arteries
Arteries are blood vessels that carry blood from the heart to the rest of the body.

Aorta
The aorta is a large blood vessel that runs down the abdomen and transports blood away from the heart.