A carotid endarterectomy removes plaque from one of two arteries that move blood to your head in order to prevent complications.

You have two carotid arteries in your neck that bring blood into your neck, face, and brain.

A carotid endarterectomy (CEA) removes plaque from these arteries and helps blood flow to your brain more easily to prevent complications associated with restricted blood flow.

More commonly than flow restriction, carotid artery plaque can cause problems by breaking off from the carotid arteries and traveling to the brain. This process is called embolization.

Here are answers to some of the most frequently asked questions about carotid endarterectomy, including when it’s needed, what risks and complications are possible, and what to expect during and after the procedure.

When the carotid arteries become narrowed or blocked, blood doesn’t flow properly into the brain. This is due to atherosclerosis, a hardening of the arteries, which refers to a buildup of plaque. As your arteries continue to narrow, your chances of having a stroke increase.

CEA is done to treat conditions that cause the carotid arteries to narrow and restrict how well blood can flow through them.

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Carotid endarterectomy. Illustration by Jason Hoffman

Over time, plaque made of fat, cholesterol, calcium, and other waste products can create blockages in your carotid arteries. This can damage brain cells due to the lack of oxygen being delivered to your brain and eventually block blood flow — which can cause strokes.

CEA can open up blockages of plaque in your carotid arteries and reduce your risk of complications, like strokes or ministrokes.

Doctors only recommend CEA when the blockage becomes advanced, which is defined as greater than 70%.

Although the risk of complications is low and the procedure is generally considered safe, there’s still a small risk of serious complications that could lead to death, such as stroke or heart attack.

Factors that can increase the risk of complications include:

  • how severe the blockages are in your carotid arteries
  • where the blockages are located
  • whether you’ve already had a stroke or ministroke
  • having other conditions, like diabetes
  • how old you are

Possible complications of CEA include:

A CEA takes about 1.5 to 2.5 hours. You may need to stay in the hospital for up to 2 days after the surgery.

Before the procedure

To prepare for the surgery, a surgeon and their team will:

  1. Ask you to take off any jewelry or accessories.
  2. Have you change into a hospital gown.
  3. Put in an intravenous (IV) tube and catheters to give you nutrients and monitor your vital signs.
  4. Use local or general anesthesia to sedate you or keep you asleep so you don’t feel pain.

During the procedure

During the procedure, a surgeon and their team will:

  1. Cut an incision over the artery they will operate on.
  2. Cut another incision into the artery.
  3. Sometimes insert a shunt to let blood flow around the operating area into the brain during the surgery.
  4. Use specialized tools to remove plaque from the artery.
  5. Take out the shunt and close the incisions in the artery and neck.
  6. Occasionally attach a drainage tube to your neck to drain any blood that leaks from the incision.

After the procedure

You will be taken to a recovery room to monitor your vital signs. Once you stabilize, you’ll be brought back to your hospital room. Then:

  1. After several hours, a doctor or nurse will help you walk around your room.
  2. At least 1 day after surgery, a nurse will remove any drainage tubes from your incision.
  3. You will be given solid food when you feel ready to eat.
  4. A doctor will schedule follow-up appointments to monitor how your carotid arteries heal. They may also prescribe medications to help manage pain. Follow their advice about taking any oral pain relievers, which may include taking aspirin daily.

Recovery from CEA takes a couple of weeks. Here’s what a doctor might recommend you do to promote healing:

  • Clean your incision area regularly until the adhesive strips fall off or your doctor removes your stitches.
  • Attend all your follow-up appointments. Your doctor will look at your artery with an ultrasound to monitor any new plaque buildup over time. They will tell you when it’s OK to continue your usual diet and daily activities, like driving, exercising, and bathing.
  • Consider dietary changes to remove or limit processed foods high in cholesterol or fat to prevent plaque buildup. You can add more fruit, vegetables, and high fiber foods to your diet.

How long you live after CEA can depend on your risk factors. But the overall outlook for people who get this surgery is very good.

A 2018 study with over 73,000 people who received CEA — with an average age of 70 — found less than 13% of them died 5 years after the surgery.

A 2019 study with 473 people over 80 years old who received either CEA or a carotid stent found that up to 67.6% of people could expect to live another 5 years or more.

Your doctor may recommend getting a carotid artery stent placed if you’re older or have another severe illness. It’s a less risky procedure than CEA and is less invasive than removing the plaque from the artery.

To place a stent, a surgeon inserts a catheter into the artery through a blood vessel in your neck. They then inflate a tiny balloon to widen the artery and insert a mesh tube made of metal to keep the artery from narrowing.

Medical emergency

Contact a doctor right away if you notice any of the following symptoms after a carotid endarterectomy:

  • fever
  • bleeding that won’t stop near your incision
  • feeling weak or losing sensation on only one side of your body
  • having trouble seeing, or seeing double
  • having trouble talking
  • a painful headache that comes on suddenly
  • drooping on one or both sides of your face
  • feeling weak or losing sensation in one arm
  • losing consciousness

CEA is considered a relatively low risk surgery that reduces blockages in your carotid arteries that can increase your risk of stroke. The earlier you get CEA, the less likely you’ll have a stroke due to a carotid artery blockage.

Contact a doctor if you’ve had any symptoms of a ministroke or are concerned that you may be at risk of carotid artery blockages, especially if you’ve had narrowing of your arteries anywhere else in your body.