Carotid endarterectomy (CEA) is done in a hospital. The surgery usually takes about 2 hours.
You will have anesthesia (AN-es-THE-ze-ah) during the surgery so you don't feel pain. The term "anesthesia" refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep. Local anesthesia numbs only certain areas of your body.
Your surgeon may choose to give you local anesthesia so he or she can talk to you during the surgery. This allows the surgeon to check your brain's reaction to the decrease in blood flow that occurs during the surgery.
During CEA, your surgeon will make an incision (cut) in your neck to expose the blocked section of the carotid artery. He or she will put a clamp on your artery to stop blood from flowing through it.
During the procedure, your brain gets blood from the carotid artery on the other side of your neck. However, your surgeon also may use a tube called a shunt to move blood around the narrowed or blocked carotid artery.
Next, your surgeon will make a cut in the blocked part of the artery. To remove the plaque, he or she will remove the inner lining of the artery around the blockage.
Finally, your surgeon will close the artery with stitches and stop any bleeding. He or she will then close the incision in your neck.
If you have small arteries or have already had a CEA, your surgeon might place a patch over the cut in the artery before closing the incision in your neck. The patch may reduce the risk of stroke for some patients.
The illustration shows the process of carotid endarterectomy. Figure A shows a carotid artery with plaque buildup. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows how the carotid artery is cut and how the plaque is removed. Figure C shows the artery stitched up and normal blood flow restored. The inset image shows a cross-section of the artery with plaque removed and normal blood flow restored.
Some surgeons use another technique called eversion carotid endarterectomy. For this surgery, one of the branches of the carotid artery is cut and turned inside out. The plaque is then cleaned out and the artery is reattached.