This page gives information about an operation called carotid endarterectomy which is done to remove blockages in the arteries in the neck. It provides information about how the operation can help and the possible risks of surgery. Please read it carefully and let us know if you have any concerns or questions. You may wish to show it to your friends and family.
The carotid arteries are the blood vessels that carry blood from the heart to the head and brain. There is one carotid artery on each side of the neck. The carotid arteries are very important as they supply blood to the part of the brain which controls thinking, speech, sensation, and movement. The brain needs a constant supply of glucose and oxygen which are carried in your bloodstream.
Carotid artery disease occurs when the arteries become narrow or blocked due to a fatty build-up called plaque. This process is called atherosclerosis. Plaque builds up for a number of reasons which include high blood pressure, diabetes, smoking and high levels of cholesterol in your blood.
Over time, the narrowing may become so severe that there is not enough blood flow into the brain. When blood flow to the brain is reduced or stops altogether, the result is called an ischemic event. This could be a stroke, can cause a permanent loss of brain function, or a transient ischemic attack which is a temporary alteration of brain function. A stroke can also occur if a piece of plaque or a blood clot breaks off from the wall of the carotid artery and travels to the smaller arteries of the brain causing a blockage. Carotid artery disease is one of the most common causes of a stroke.
A carotid endarterectomy is an operation to remove plaque from one of the carotid arteries allowing better blood flow to the brain. Carotid endarterectomy may be performed if you have had a transient ischaemic attack (mini stroke) or a major stroke.
This is usually done under a general anaesthetic, but it is sometimes possible to have the operation under local anaesthetic.
The main benefit of the operation is to reduce the risk of another transient ischaemic attack or stroke in the future. Most patients who are offered carotid endarterectomy have a high chance of another transient ischaemic attack or stroke if they do not have surgery.
As with any operation there are risks associated with carotid endarterectomy. They include:
Stroke – a small number of people (between one and three in every hundred) who have a carotid endarterectomy will have a stroke during or soon after the operation.
The stroke can vary in severity, but a severe stroke can cause a major disability or even death. All possible precautions will be taken to prevent this.
Nerve injury – this is rare. Some of the problems which are caused by a nerve injury include loss of sensation of the skin on your neck or changes to your voice. Movement of nerves near the carotid artery can lead to temporary or rarely permanent loss of function.
Fluid leak from the wound – sometimes the wound can bleed or bleeding under the wound can cause swelling. Usually, the swelling will settle on its own but sometimes the wound may need another surgical operation.
Wound infection – this is uncommon and will usually settle with antibiotics.
Wound haematoma – a haematoma is a collection of blood which forms near the wound. It will usually go away on its own.
Your risk of a major complication may be higher than normal. Things which increase the level of risk include your age, if you smoke, if you have had a stroke or transient ischaemic attack before, or if you have another health problem such as heart disease, high blood pressure or diabetes. We strongly recommend that you stop smoking as continuing to smoke makes your recovery harder and can cause further damage to your arteries.
If your surgical risk is higher than normal, then your surgeon will discuss this with you. It is important to remember that your surgeon will only recommend treatment if they believe that the risk of a stroke or other problem without an operation is much higher than the risks of having the operation.
There are also risks associated with having a general anaesthetic. If you are having a general anaesthetic, you will see an anaesthetist on the day of your operation who will discuss the risks with you.
The main treatment for carotid artery disease is a carotid endarterectomy and we will recommend this surgery to most patients.
A small number of patients may be able to have treatment which involved involves placing inserting a stent (a wire mesh tube) at the site of through the narrowing in the carotid artery. Your surgeon will discuss this procedure with you if they think it may help you.
Before you have a carotid surgery, there are a number of tests you will need to have to assess whether it is the right procedure for you and you are able to have the operation.
Tests include:
- Ultrasound scan of your carotid artery (scan of your neck).
- CT scan (special X-ray scan) of your brain and the blood vessels in your neck and head.
- A special MRI scan of your brain and the blood vessels in your head and neck.
- Blood tests.
- ECG (a recording (‘trace’) of the electrical activity of your heart).
- Echocardiogram (an ultrasound test of the heart).
- Breathing test (lung test).
These tests should have been done within a couple of days of being seen due to your symptoms. If you are fit enough, you will then be offered an operation within two weeks of your symptoms.
Before your operation, we will organise a pre-assessment appointment either by telephone or in-person (or both). We will ask you for details of your medical history and carry out any tests we need to make sure you are fit for the anaesthetic and the operation. Staff in pre- assessment will tell you how to prepare for your operation, when to stop eating and drinking and about the admission process.
You will be admitted to hospital on the day of your operation or the day before. Please bring your usual medications with you. You will meet a member of the anaesthetic team and a member of the surgical team before the operation. They will explain the risks and benefits of the procedure and they will obtain your consent. Staff will also mark the operation site on your neck with a pen.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Surgeon or team member will explain all the risks, benefits, and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please speak with a senior member of staff again.
Most operations take around two to three hours, but more complex procedures can take longer.
The surgeon will make a cut in your neck around seven to ten centimetres long so that they can access the carotid artery. The carotid artery will then be clamped to stop blood flowing through it.
Sometimes the surgeon will use a small plastic tube called a shunt to maintain blood flow to the brain during the operation. The shunt is placed at either side of the section of the carotid artery which is being operated on.
The surgeon will make a cut along the length of the artery and will then carefully remove the plaque. The artery will then be closed using a patch which helps to prevent the artery narrowing again in the future.
The wound is then closed using stitches. These will usually dissolve on their own, but in a small number of cases they need to be removed a week or so after surgery. We will tell you if this is needed.
The surgeon may place a small plastic drain tube in your neck so that any blood which builds up does not cause swelling. The drain is usually removed the next day.
After the operation you will wake up in the Recovery Area. You will then be taken to the High Dependency Unit where you will stay until you are well enough to move to the ward.
After your operation your blood pressure is likely to be higher than normal. We will give you medication to control your blood pressure if this is needed. Some patients need to stay in the High Dependency Unit one to two days longer until their blood pressure is lowered.
You may have a urinary catheter (a soft tube placed into the bladder) which allows urine to drain into a bag. This will be removed when you are able to pass urine without the catheter.
You will have a dressing over your wound. The nurses on the ward will change your dressing each day you are in hospital. Your wound may be painful. Please ask for medication to help your pain as soon as you need it to avoid the pain getting worse.
Most patients are able to eat and drink normally on the day after their operation.
Most patients stay in hospital for around two to four days.
There is often some swelling in the neck, but this settles within 7-10 days. The incision (cut) on your neck will initially be very visible, however this will become invisible within 2-3 months.
If you have a loss of consciousness, have a fit, or new symptoms of a stroke you must call 999 immediately.
Wound care
Your wound may be sore for about one week and may also feel swollen and bruised. This usually improves seven to ten days after the operation. It is a good idea to have a supply of paracetamol at home before you come in for your operation. If you take ibuprofen, please make sure you take it when you eat.
Please try to avoid the wound getting wet. We suggest that you shower, instead of taking a bath, until we see you again in clinic.
There will be small strips of tape over your wound under the dressing. Please leave these on for at least one week after your operation. You do not need to change your dressing unless it gets wet. We will give you some spare dressings so you can do this at home if you need to. Please ask your nurse for these before you go home.
If there are stitches or clips, are the type that need removing whilst you are still in the hospital.
The wound will be clearly visible at first will fade and in most cases will be almost invisible after two to three months.
If your wound opens or bright red blood soaks through the wound dressing, please contact the Clinical Nurse Specialist, or the ‘on call’ Vascular Surgery Registrar on call outside of office hours (see ‘Contact details’ below).
If you have a fever, pus comes from the wound or if you develop redness around the wound, please contact your GP as soon as possible for advice.
Medication
Most patients will be prescribed medication to thin their blood to take for a few weeks after the operation. This helps to prevent a blood clot forming. This will be reviewed when you see us again in clinic. You can take your other medications as normal.
Exercise and going back to work
You should rest when you feel tired. Taking rest and getting enough sleep will help your recovery.
Try to take a walk each day, building up gradually. Start by walking around the house or garden.
We advise you to avoid heavy lifting or heavy exercise for two weeks after the operation.
You should be well enough to drive two to three weeks after surgery. We recommend that you check with your GP before starting to drive after your surgery.
We usually advise patients to take three to four weeks off work, but this can vary, depending on the type of work you do and how you feel.
Eating and drinking
Try to drink plenty of fluids (one and a half to two litres of water per day) unless the medical team specifically tell you not to.
We will give you an appointment to review you in outpatient clinic around six to eight weeks after the operation. You may need an ultrasound scan of your neck before your appointment to check how well the operation has gone – this will be booked for you if necessary. Your follow-up appointment will take place at University College Hospital.
Information about vascular surgery
The Circulation Foundation is the UK vascular disease charity.
The Vascular Society UK is the society for UK Vascular Surgeons. Their website also has information for patients.
Support with giving up smoking
Smoke Free NHS Helpline: 0800 123 1044
BREATHE Camden and Islington: 020 3633 2609
UCLH cannot accept responsibility for information provided by other organisations.
Clinical Nurse Specialist (Monday to Friday 08:00-16:00)
Direct line: 0203 447 5494
Switchboard: 08451 555 000 / 020 3456 7890 ext. 75494
Mobile: 07908 439910
On call Vascular Surgery Registrar (out of hours)
Call the hospital switchboard (08451 555 000 or 020 3456 7890) and ask the operator to “bleep the on call Vascular Registrar.”
Email: uclh.
Admission Co-ordination Team
Direct line: 020 3448 3081
Switchboard: 08451 555 000 / 020 3456 7890 ext. 83081
E-mail: uclh.
Address: National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG
Patients who are having carotid endarterectomy will have their surgery at the National Hospital for Neurology and Neurosurgery, Queen Square.
Outpatient follow-up appointments will take place at University College Hospital.
Page last updated: 26 February 2025
Review due: 01 April 2026