Endarterectomy is performed to remove plaque located inside an artery. Plaque is a fatty, waxy deposit which slowly builds-up in the arteries over time and affects them by making them thicker and narrower. This is known as atherosclerosis. This will reduce the amount of oxygen and blood being provided to organs connected to these blocked arteries. In addition, plaque may rupture, spilling cholesterol and other substances into your bloodstream. This can lead to a blood clot, which can block the blood flow to a specific part of your body. If the blocked artery supplies the heart or brain, a heart attack or stroke occurs.

Most often than not, an endarterectomy is performed on the carotid arteries. The carotid arteries are the major blood vessels in the neck that supply blood to the brain, neck, and face. However, an endarterectomy can be performed in other areas of the body including: aorta (largest artery in the body), iliac and femoral arteries (arteries in the legs), and renal arteries (arteries in the kidney).

An endarterectomy can be performed using the following methods: non-invasive (no incisions required / small puncture / low to moderate sedation) or minimally-invasive (small incisions of 2–3 inches long / general anesthesia). The type of method chosen will vary according to your particular health condition.

  • A potential complication of an endarterectomy and stent placement for stroke prevention is a stroke occurring during the procedure. Therefore, our surgeons are performing a new minimally-invasive procedure, called transcarotid artery revascularization (TACR). Please read below for the procedure description.

How to prepare for the procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Other recommendations include:

Talk to your doctor about

  • All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
  • Diabetes and how to adjust your medicine on the day of the procedure
  • Radiation exposure, especially for those that are pregnant
  • Any allergies to medicines, latex, tape, iodine, and anesthetic agents
  • Any history of bleeding disorders
  • Any implanted device (e.g. pacemaker or ICD)
  • Any body piercings on your chest or abdomen

Other suggestions

  • Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
  • Leave all jewelry at home
  • Remove all makeup and nail polish
  • Wear comfortable clothing when you come to the hospital.
  • If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to expect before the procedure

Before the procedure, your doctor may perform a variety of tests, including:

Diagnostic tests and procedures

What to expect during the procedure

An endarterectomy usually lasts 1 to 2 hours. The procedure is usually performed in the operating room (OR). Check with your doctor about the details of your procedure. In general , during a transcarotid endarterectomy:

  • You will change into a hospital gown.
  • A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
  • Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
  • You doctor may choose regional anesthesia instead of general anesthesia. Regional anesthesia is delivered through an epidural (in the back) to numb area operated on. While general anesthesia will make you feel sleepy. The doctor will determine which type of anesthesia is appropriate.
  • The procedure begins when your doctor makes an incision down the side of your neck over the diseased artery. Once the artery is exposed, the provider will make a cut into the artery and remove the plaque deposits clogging your artery.
  • Your doctor may use a device called a “shunt” to divert blood flow around the surgery area. This will keep blood flowing to the brain to protect against dangerous debris from reaching the brain during the procedure.
  • Your doctor will then filter the blood before returning it to a vein in the groin, and place a stent directly into the carotid artery to stabilize the plaque and prevent future strokes.
  • After the procedure is complete, your doctor will remove the “shunt” and carefully close the artery. The incision in the neck will also be closed off with the use of a sterile bandage or dressing.

What to expect after the procedure

After the procedure, you may be taken to the recovery room or intensive care unit (ICU) for further observation. Generally speaking, after this procedure, you’ll be able to go home within 1 to 2 days. Other recommendations include:

General guidelines

  • A nurse will monitor your vital signs and the insertion site.
  • If drainage tube was placed in the incision during the procedure, your doctor will likely remove it next morning.
  • You may be on medications for pain relief, to help your blood pressure, and to control any problems with bleeding.
  • At the appropriate time, you will be helped out of bed to walk around as you can handle it.
  • Your doctor will give you instructions to follow during your recovery.