Home Page

Date issued: December 2023

Review date: December 2025

Ref: A-597/JW/Cardiology/Carotid Endarterectomy

PDF: Carotid Endarterectomy.pdf [pdf] 232KB

The carotid artery in the neck provides the principal blood supply to the brain. The artery (common carotid artery) runs up the side of the neck and divides into two branches just below the angle of the jaw. One branch supplies the face (external carotid artery). The other branch passes directly to the brain with no other branches in the neck (internal carotid artery).

Arteries tend to narrow where they divide. Narrowing at the carotid bifurcation (division of common carotid artery) may directly restrict the blood supply to the brain. Additionally and more importantly, debris stuck to the narrow area may break off and fly into the brain or into the artery to the eye. The combination of TIA, CVA, or amaurosis fugax and tight narrowing of the carotid artery put you at risk of major stroke.

What are the treatments?

A Carotid endarterectomy is an operation to unblock the narrowed carotid artery. The artery is carefully exposed through an incision running vertically in the side of the neck. The artery is opened, cleared of the debris and carefully sewn up again. The operation is usually done under local anaesthetic. During the operation, if you become uncomfortable, the Surgeon will inject more local anaesthetic. You will also be given some sedation and, as a result, you may not be very aware of the operation at all.

What happens after the operation?

You will spend some time in recovery after theatre. After your operation, you will return to the ward where you will be monitored by the doctors and nurses. You may be given fluids by a drip in one of your veins until you are well enough to sit up and take fluids and food by mouth. The nurses and doctors will try and keep you free of pain by giving pain killers. Local anaesthetics are used to numb the skin so there should be little discomfort.

You may have a drain from your wound attached to a bottle to remove any blood from the operation site. This will usually be removed the day after your operation.

Your mobility will return to normal more or less immediately. There is often some swelling in the neck, but this settles within 7-10 days. The incision, although initially very visible, will subside to become virtually invisible within 2-3 months.

Most people stay in hospital for 1 night after carotid endarterectomy and go home the next day.

Possible Complications

Chest infections: (Common)These can occur following this type of surgery, particularly in smokers, and may require treatment with antibiotics and physiotherapy.

Wound infection: (Uncommon) This may need treatment with antibiotics.

Fluid leak from wound: (Common) Occasionally the wound can bleed or bleeding beneath the wound can cause swelling.

Nerve injuries: (Uncommon). A nerve may occasionally be injured leading patch of numbness in the neck. The Vagus Nerve provides a branch to the voice box (larynx). Damage to it, which happens only very rarely, leads to a hoarse voice. The Hypoglossal Nerve supplies the muscles of the tongue. Damage to it, again rare, will affect speech slightly by reducing the tongue’s mobility. The Facial Nerve supplies the muscles of the face. Damage to its lowest branch may lead to impaired movement of muscles around the lower jaw and neck. Again, this is rare.

Stroke : (Rare)

Swallowing Difficulties: (Very Rare) Requiring a feeding tube to be inserted through the nose down into the stomach.

Other Major Complications: (Rare) As with any major operation, there is a small risk of you having a heart attack, kidney failure or chest problems.

Going Home

Your Dressing will usually be removed before discharge if you have any sutures or clips that need removing later this will either be done at your GP practice or by the district nurses if you are housebound.

Driving: You can drive when you can safely perform an emergency stop. This is usually 2-3 weeks post surgery. If you have any concerns please contact your insurance company.

Bathing: When your wound is dry you can bathe and shower as normal

Work: You will be able to return to work 2-3 weeks post surgery. We will provide you with a sick note for this.

Exercise: You can resume regular exercise such as a short walk combined with rest for the first few weeks and then gradually return to normal activity.

Lifting: You should avoid heavy lifting or straining for 6 weeks.

Who to contact If I have any concerns?

Less than 24 hours post discharge:

Call 01752 202082 and ask for the ward you were discharged from.

After 24 hours post discharge:

Urgent Medical Help: 111 or 999

Pain/ medication concerns: GP

Operation specific questions: Consultant’s Secretary or Vascular Specialist Nurse

Consultant Vascular Surgeon and Lead Clinician

Mr Devender Mittapalli

Secretary: 01752 431822

Consultant Vascular and Transplant Surgeon

Mr Jamie Barwell

Secretary: 01752 431822

Consultant Vascular Surgeon

Surgeon Commander Cris Parry RN

Secretary: 01752 431822

Consultant Vascular Surgeon

Miss Catherine Western

Secretary: 01752 431805

Consultant Vascular Surgeon

Lt Col Robert Faulconer

Secretary: 01752 431805

Consultant Vascular Surgeon

Mr Hashem Barakat

Secretary: 01752 431822

Vascular Nurse Specialist

Mr Alan Elstone

Miss Jess Webster

01752 431805

What can I do to help myself?

• Quit Smoking

• Lower Cholesterol

• Keep active

• Control blood sugar levels in diabetes

• Maintain a healthy diet

• Maintain a healthy blood pressure

The nurse looking after you will be able to give you information/resources for any of these that are relevant to you.