The carotid arteries in the neck carry blood to the brain. Over time, a fatty plaque can narrow them and, if a piece breaks off or the artery blocks, a stroke can follow. Carotid endarterectomy removes the plaque through an incision in the neck. Carotid stenting opens the artery from inside, using a small mesh tube placed through a catheter.
Who it may help
- A transient ischaemic attack (TIA, or mini-stroke) or a minor stroke
- A significant narrowing of the carotid artery on Doppler ultrasound or CT angiography
- Dizziness, brief loss of vision in one eye, or weakness on one side that comes and goes
- Risk factors for artery disease, including diabetes, smoking, high blood pressure and high cholesterol
Conditions treated
- Carotid artery stenosis
- Carotid artery dissection
- Radiation-related carotid disease
- Narrowing on both sides
- Patients who are at higher risk for open surgery and suit stenting
Treatment options
- Carotid endarterectomy (CEA) The artery is opened through a neck incision, the plaque is removed and the artery is closed. It may be done under local or general anaesthesia.
- Carotid artery stenting (CAS) A stent is placed through a catheter, usually from the groin, to hold the artery open. It is often considered for people at higher risk from surgery.
- Combined planning When there are blockages in the brain’s vessels as well, treatment is planned together with a neurologist and cardiologist.
Before the procedure
- Carotid Doppler, CT or MR angiography, or DSA
- Heart check and anaesthesia fitness
- Review of blood-thinning medicines
- A discussion of the risks with the family
- Antiplatelet medicines started before stenting
Recovery: what to expect
- Endarterectomy: about 2 to 3 days in hospital.
- Stenting: often 1 day or day-care.
- Monitoring of blood pressure and neurological status for the first 12 to 24 hours.
- Return to normal activity in 7 to 10 days, sooner after stenting.
- Doppler follow-up at about 1, 3 and 6 months.
- Medicines, diet and exercise advice for the long term.
These are typical timings. Your own plan depends on your condition, your general health and the operation chosen, and Dr. Chakraborty will go through it with you.
Risks to know about
Every operation carries risk. The ones most relevant here are:
- Stroke during or soon after the procedure
- Bleeding or swelling in the neck
- Damage to small nerves near the incision, causing numbness or hoarseness
- Re-narrowing of the artery over time
- Heart problems in people with heart disease
Your own risks depend on your health and your scans, and are explained in detail before you decide on anything.
Common questions
Which is better, surgery or stenting?
Neither is better for everyone. Stenting is often favoured for older or higher-risk patients and surgery for others. The choice is based on your health and the shape of the plaque.
Will the blockage come back?
It can, though it is uncommon with good medicine and lifestyle control. Follow-up scans check for this.
Does this cure stroke?
It does not undo a stroke that has already happened, but it lowers the risk of another one.
Will I need medicines afterwards?
Yes. Usually antiplatelet medicines for some months and a cholesterol-lowering tablet for the long term.
This page is general information to help you prepare for a consultation. It is not medical advice and does not replace an examination. Every plan is made for the individual patient.