Carotid endarterectomy: a surgical procedure aimed at reducing the risk of stroke

Carotid endarterectomy to reduce the risk of stroke

The Carotid Pathology Unit at Publio Cordón Memorial Hospital specialises in the diagnosis and treatment of conditions affecting the arteries in the neck that supply blood to the brain.

One of the most effective procedures for certain patients is carotid endarterectomy, a surgical procedure aimed at reducing the risk of stroke when there is significant narrowing of the carotid artery.

This narrowing, known as carotid stenosis, is usually caused by the gradual build-up of fatty and calcium deposits on the artery wall. When the blockage reaches a certain level, it can impede blood flow to the brain or promote the formation of clots that may trigger a stroke.

Carotid endarterectomy allows the plaque narrowing the artery to be removed directly, restoring blood flow and reducing the risk of neurological complications.

The decision to proceed with this treatment is always made following an individual assessment by specialists in carotid disease and stroke prevention.

In which cases is this treatment recommended?

Carotid endarterectomy is recommended for patients with significant narrowing of the carotid artery and a high risk of stroke.

The indication depends on several factors, including the degree of narrowing of the artery, the presence of neurological symptoms and the patient’s general state of health.

It is often considered for people who have experienced transient neurological episodes — such as a transient ischaemic attack (TIA) — or a minor stroke related to carotid stenosis.

It may also be considered in patients without previous symptoms when imaging tests show significant narrowing of the artery that increases the risk of embolism to the brain.

The decision on treatment is always made following an individual assessment of each patient’s neurological and cardiovascular risk.

What benefits can the treatment offer?

The main aim of carotid endarterectomy is to reduce the risk of stroke in patients with significant carotid stenosis.

By removing the plaque that narrows the artery, the procedure restores adequate blood flow to the brain and reduces the likelihood of plaque fragments or clots travelling to the cerebral arteries.

In patients who have already experienced neurological symptoms, the procedure can help prevent further episodes and reduce the risk of permanent neurological damage.

From a clinical perspective, this procedure is primarily aimed at preventing one of the most serious complications of cerebrovascular disease.

Diagnostic assessment of carotid stenosis

Before recommending a carotid endarterectomy, a diagnostic assessment must be carried out to confirm the degree of narrowing of the artery and to assess the risk of stroke.

The most commonly used initial test is carotid Doppler ultrasound, which measures blood flow and assesses the degree of stenosis.

In many cases, the assessment is supplemented by computed tomography angiography (CTA) or magnetic resonance angiography (MRA), which provide a detailed image of the arteries in the neck and brain.

In addition to imaging tests, the medical team carries out a comprehensive assessment of the patient’s cardiovascular status to determine the most appropriate treatment strategy.

How the treatment is carried out

Carotid endarterectomy is a surgical procedure designed to remove the plaque that is narrowing the carotid artery and to restore adequate blood flow to the brain.

The surgery is usually performed under general anaesthesia, although in selected cases it may be carried out under regional anaesthesia. This option allows the patient to remain awake and enables the surgeon to directly assess neurological function during critical stages of the procedure.

The surgeon makes a small incision on one side of the neck, over the affected carotid artery. Through this incision, the artery is carefully identified and blood flow is controlled to ensure the procedure can be carried out safely.

Once the vessel is exposed, the artery is opened to gain access to its interior and remove the atheromatous plaque causing the narrowing. This step allows the arterial wall to be cleared and the artery’s normal diameter to be restored.

After removing the plaque, the artery is reconstructed using precise sutures. In many cases, a small vascular patch is also inserted to reinforce the arterial wall and help maintain adequate blood flow. Once normal blood flow to the brain has been restored, the incision in the neck is closed.

The procedure usually lasts between one and two hours.

During the operation, the team continuously monitors cerebral perfusion either through direct clinical monitoring in awake procedures, or via intraoperative neuromonitoring systems when the procedure is performed under general anaesthesia.

Recovery and follow-up

Following surgery, the patient remains under observation for the first 24 to 48 hours in a specialist unit, where their neurological and cardiovascular status is monitored.

In most cases, recovery is rapid and the patient is discharged from hospital within a few days.

Subsequently, clinical check-ups and imaging tests are carried out to ensure that the artery maintains adequate blood flow and that the patient is making a favourable recovery.

Medical follow-up also includes monitoring cardiovascular risk factors, such as high blood pressure, high cholesterol and smoking, which influence the progression of arterial disease.

Specialist assessment at the Carotid Pathology Unit

The decision to perform a carotid endarterectomy requires a rigorous and personalised clinical assessment.

At the Carotid Pathology Unit at Publio Cordón Memorial Hospital, each case is analysed individually with the aim of determining the most appropriate treatment strategy to reduce the risk of stroke and preserve the patient’s neurological health.

This specialist assessment allows us to take into account the results of diagnostic tests, the patient’s general condition and the various treatment options available.