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Endarterectomy is the removal of plaque from the carotid artery through an incision in the neck. This surgery has very low risk of stroke or complication. It typically involves a quick recovery with little pain. You may be asleep under general anesthesia during surgery, or awake, with local anesthesia to control pain. This will be discussed with you before surgery.
Making the skin incision: The surgeon makes an incision in the skin over the carotid artery. The image above shows a common incision site and length.
Opening the artery: The surgeon places clamps on the artery above and below the blockage. This temporarily stops blood flow. The surgeon then makes an incision in the artery itself.
Placing a shunt: A shunt may be used to preserve blood flow to the brain during the procedure. After the shunt is in place, the clamps are removed from the internal carotid artery. In some cases a shunt is not needed because the brain is receiving enough blood through other arteries.
Removing plaque: The surgeon loosens plaque from the artery wall. The plaque is then removed, often in a single piece. The surgeon inspects the artery to confirm that all of the plaque has been removed. He or she then closes the incision using either sutures or a patch.
Suturing: The surgeon may suture (stitch) the incision closed. The clamps are then removed. Next, the skin incision is sutured closed. A tube (drain) may be put in place to keep fluids from collecting around the area.
Patching: The surgeon may close the artery with a patch of strong, flexible fabric. The clamps are then removed, the skin incision is sutured, and a drain may be put in place.