Carotid Endarterectomy & Stenting

Why treat a narrowed carotid artery?

The carotid arteries carry blood to the brain, and a cholesterol plaque at the carotid bifurcation can shed fragments that cause a stroke or mini-stroke (TIA). When a narrowing is significant — particularly when it has already caused symptoms — treating the plaque itself, alongside proper medication, lowers the risk of the stroke that matters: the next one. The background is covered on the carotid artery disease page.

Carotid endarterectomy

Endarterectomy is the operation with the longest track record: through a neck incision under general or local anaesthesia, the artery is opened and the plaque is removed directly, usually with a patch to widen the closure. It remains the benchmark treatment for most symptomatic, significant narrowings in patients fit for surgery. Recognised risks include stroke during or after surgery, cranial nerve irritation causing temporary voice or tongue weakness, and neck bruising — which is exactly why the decision weighs your surgical risk against your stroke risk, case by case.

Carotid stenting

Stenting treats the narrowing from within: a stent is deployed across the plaque through a puncture in the groin or arm, with a protection device to catch debris. It avoids a neck incision, which makes it valuable for anatomically hostile necks — previous surgery or radiotherapy, a narrowing that sits too high to reach well — and for selected patients whose medical condition makes open surgery unattractive. Timing, plaque character and aortic arch anatomy all feed the choice.

What to expect

Both procedures typically involve a short hospital stay of one to a few days, close blood-pressure monitoring afterwards, and lifelong antiplatelet and statin therapy — the medication is not optional; it is half the treatment. Follow-up ultrasound keeps an eye on the treated artery.

Is it right for me?

If a scan has shown a carotid narrowing — or you have had a TIA — the assessment is urgent rather than elective, because the risk of stroke is highest in the first days to weeks after symptoms. At consultation the imaging is reviewed, and I go through whether medication alone, endarterectomy or stenting fits your narrowing and your fitness.