Endarterectomy, a surgical procedure that clears away blockage in an artery, is most often performed on the carotid arteries to prevent stroke. It’s an alternative to stenting and is only done in certain circumstances.

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Plaque buildup along the inner wall of an artery can restrict blood flow and lead to serious complications. One treatment option is an endarterectomy, a surgical procedure that involves cutting into the narrowed artery to remove the deposits of fat, cholesterol, and other substances.

An endarterectomy is usually associated with the carotid arteries, which carry blood to the brain. Removing plaque in a carotid artery can help reduce the risk of stroke.

An endarterectomy helps restore healthy blood flow through an artery that had a blockage due to plaque buildup. In the carotid arteries, which are located on each side of the neck, blockage means reduced blood flow to the brain. Over time, interrupting the steady flow of oxygenated blood can affect brain function.

Arterial plaque can also rupture, triggering a blood clot formation. A clot can block blood flow, resulting in an ischemic stroke if the blockage occurs in a carotid artery. Among people with severe carotid artery stenosis (narrowing of the artery of 70% to 99%), an endarterectomy may reduce the 2-year stroke risk by 80%, according to the National Institute of Neurological Disorders and Stroke.

An endarterectomy performed in another artery can also reduce the risk of blood clot formation and any complications that might develop.

There are four main types of endarterectomy, each one performed in a different part of the body. But the procedure for removing plaque buildup is essentially the same, regardless of which blood vessel is affected.

  • Aortic endarterectomy: This type is performed on the aorta, the large blood vessel supplying blood to the organs and tissue in the abdomen.
  • Carotid endarterectomy: This type is performed on the carotid arteries.
  • Femoral endarterectomy: This type is performed on the femoral arteries running from the groin to the lower legs.
  • Iliac endarterectomy: This type is performed on the iliac arteries that provide blood to the legs and the organs and tissue in the pelvic area.

General or local anesthesia may be used during an endarterectomy. It depends on the specific procedure and your preference.

The procedure begins with an incision above the affected artery.

For example, during carotid endarterectomy, an incision is made along the side of the neck. When the surgeon reaches the artery, an incision is placed in the artery. The healthcare team may then place a shunt in the artery to route blood around the blockage to make sure it reaches the brain throughout the operation.

The surgeon uses a special tool designed to remove plaque. Sometimes it can be removed in one piece, but in most cases, the plaque comes out in several small, hard pieces.

Once the surgeon has made sure all the plaque is gone, the shunt is removed, and the artery is closed. The surgeon will then use stitches to close the skin incision.

You will likely be discharged from the hospital a day or two after an endarterectomy.

Once you know the scheduled date for your endarterectomy, talk with your doctor about when you should stop taking certain medications or whether it’s safe to take your medications on schedule through the day of your surgery. Follow all instructions you’re given regarding eating and drinking prior to your procedure.

If your doctor recommends an endarterectomy, some of the questions you might want to ask include:

  • How serious is the blockage in my artery?
  • Why are you recommending endarterectomy over stenting or other treatments?
  • What is my outlook like if I don’t have an endarterectomy?
  • What negative reactions should I be aware of when I leave the hospital?

Once your blood pressure, heart rate, and breathing are stable, you’ll be moved from the operating room to the intensive care unit (ICU) or a recovery room, depending on the nature of your procedure and your overall health. Your healthcare team will monitor you overnight for signs of bleeding complications or significant changes in your blood pressure and pulse.

They may also order an ultrasound to assess your arterial health and function.

It’s important that you keep the incision area clean and dry. Stitches will be removed within a week or so. Adhesive strips will fall off within a few days.

You should be able to resume your usual diet within a couple of days. Your healthcare team will tell you about the importance of avoiding heavy lifting and strenuous activities for several days. They will also advise you about what activities are safe and when to schedule a follow-up appointment with your doctor.

If you are not already on a statin or other cholesterol-lowering medication, your doctor will probably prescribe a medication to help reduce the risk of further plaque buildup.

Research suggests that carotid endarterectomy both reduces the risk of stroke in people with carotid stenosis and improves their quality of life. A 2020 study also suggests that endarterectomy is associated with a lower risk of stroke and mortality compared with stenting to relieve blockage in a carotid artery.

A femoral endarterectomy is considered the “gold standard” for treating severe blockage in one of the femoral arteries, according to a 2020 report in the journal Vascular Health and Risk Management.

Like any surgical procedure, an endarterectomy presents some degree of risk. And because the procedure involves a direct incision into an artery, excessive bleeding is a particularly high risk. Other risks include:

There is also a risk that the affected artery may narrow again.

An endarterectomy can be an effective method to remove dangerous plaque from an artery. A carotid endarterectomy can be especially helpful in opening a narrowed carotid artery and reducing your risk of stroke.

Because the procedure involves arteries critical to supplying blood to key organs, it’s especially important to follow your doctor’s instructions after the surgery to give yourself the best chance for a full recovery and robust circulation down the road.