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JAMA Patient Page
July 7, 2020

Carotid Artery Endarterectomy

Author Affiliations
  • 1Stanford Hospital, Stanford, California
JAMA. 2020;324(1):110. doi:10.1001/jama.2020.2104

Carotid artery endarterectomy is an operation during which calcified plaque is removed from the carotid artery to reduce risk of stroke.

The carotid arteries are large blood vessels on each side of the neck that carry fresh oxygenated blood to the brain (internal carotid artery) and the face (external carotid artery). The carotid arteries may become diseased with atherosclerosis, resulting in plaque that narrows the lumen of the artery, causing carotid artery stenosis. Risk factors for carotid artery stenosis include age, smoking, diabetes, high cholesterol, and high blood pressure.

Most people with carotid plaque buildup never have symptoms. If the plaque ruptures, resulting in platelets clumping together, a piece of plaque or a clump of platelets may break off and travel to the brain, which may lead to a stroke. Patients at high risk of stroke, those with a prior stroke or smaller, self-resolving strokes (transient ischemic attacks or TIAs), and those who are about to have a major operation may be tested for carotid artery stenosis. Duplex ultrasound is used to assess the amount of plaque in the carotid arteries. Computed tomography and magnetic resonance imaging may be used if ultrasound does not provide sufficient information. Cerebral angiogram is a more invasive procedure in which a catheter is inserted directly into the blood vessels and contrast dye is used to assess the degree of carotid artery stenosis. Patients at risk or with a diagnosis of carotid artery stenosis should be taking a statin, aspirin, and blood pressure medications to minimize risk of stroke.

The Carotid Artery Endarterectomy Procedure

Current national guidelines recommend that patients who have more than 70% narrowing of the carotid artery but are without symptoms and those who have more than 50% stenosis along with symptoms be evaluated for surgery. The major risks of the operation include stroke, heart attack, or injury to the nerves that control tongue function and swallowing.

An incision is made on the side of the neck, and the carotid artery and its branches are dissected free and clamped. During clamping, some surgeons insert a temporary shunt to provide blood flow to the brain. Alternatively, surgeons may use either a blood pressure measurement from the artery or a monitor assessing brain activity to decide whether a shunt is necessary. The diseased artery is then opened and the calcified plaque is carefully removed from the inside. A patch is generally sewn around the edges of the artery to close the opening without narrowing it. The artery is then cleaned and flushed and the clamps are opened, restoring blood flow to the brain. Patients are usually observed in the hospital for any neurologic changes and typically go home the next day.

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Article Information

Conflict of Interest Disclosures: None reported.

Sources: Ricotta JJ, Aburahma A, Ascher E, et al. J Vasc Surg. 2011;54(3):832-836.

Lichtman JH, Jones MR, Leifheit EC, et al. JAMA. 2017;318(11):1035-1046.

Fereydooni A, Gorecka J, Xu J, et al. JAMA Surg. 2019;154(11):1055-1063.

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