Carotid endarterectomy

An operation to clear fatty narrowing from the main artery in the neck, done to lower the risk of a stroke.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

The operation removes fatty narrowing from a neck artery to lower your future risk of stroke — it is not done to make you feel better.
It carries a small but real risk of causing a stroke or death during or just after surgery, so the benefit has to outweigh that risk.
Benefit is greatest soon after a warning stroke or TIA, which is why it is usually done within about 2 weeks of symptoms.
For people with no symptoms the benefit is smaller; ask honestly whether surgery, stenting or medicines alone is right for you.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeSurgery on the neck artery

AnaestheticLocal anaesthetic with you awake, or general anaesthetic

How long it takesAbout 1.5–2 hours

Hospital stayUsually 1 night; sometimes a little longer

Time off workOften a few weeks; driving usually paused for 4–6 weeks

When you'll see resultsStroke-risk benefit is greatest when done soon after a warning stroke or TIA

On the NHS?Routinely done on the NHS when the artery is narrowed enough; not a cosmetic or self-pay treatment

A general guide. Your surgeon will give you advice for your situation.

Best fit

Lowers the risk of a future stroke in people with a significantly narrowed neck artery

Pause if

The artery is completely blocked (occluded) rather than narrowed — surgery does not usually help once it is fully blocked.

Main recovery point

You are watched closely, often in a high-dependency area, mainly to keep blood pressure steady and to check for any signs of stroke or neck swelling. The...

Good aftercare

Clear written stroke warning signs (FAST) and instructions to call 999, not the clinic, for any sign of stroke.

First 24 hours

You are watched closely, often in a high-dependency area, mainly to keep blood pressure steady and to check for...

Days 1–3

Most people go home after one night once they are stable and walking. The neck wound is closed with dissolvable...

Weeks 1–2

Swelling and bruising settle. Numbness around the wound and earlobe is normal and improves slowly. You can do...

Weeks 4–6

Most people can return to driving once neck movement is comfortable and they feel safe — check the official...

Medical line illustration of carotid artery and neck vessels for Carotid endarterectomy. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is a carotid endarterectomy?

A carotid endarterectomy is an operation on one of the carotid arteries — the two main blood vessels in your neck that carry blood to your brain. Over time, fatty material (plaque) can build up and narrow one of these arteries. The danger is not usually the narrowing itself, but that a small piece of plaque can break off, travel to the brain and cause a stroke or a mini-stroke (TIA).

The operation opens the artery, removes the fatty lining, and then closes the artery again — often with a small patch to keep it wide. The aim is to lower your future risk of stroke, not to make you feel better day to day. Many people feel no different afterwards, because the point of the surgery is to prevent something that has not happened yet.

It is most useful for people who have already had a stroke or TIA from a narrowed neck artery, because their risk of another stroke is highest in the days and weeks afterwards. It is sometimes considered for people with a tightly narrowed artery who have had no symptoms, but the benefit there is smaller and needs careful discussion.

This is preventive surgery that carries its own small risk of causing a stroke. The decision is always a balance between the risk of doing nothing and the risk of the operation.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Standard (open) endarterectomy

The surgeon opens the artery lengthways, peels out the fatty core, and closes it — usually with a patch to keep the artery wide. This is the most common and best-studied method.

Eversion endarterectomy

The artery is cut across, turned back on itself to remove the plaque, then re-joined. An alternative technique some surgeons prefer; outcomes are broadly similar.

Surgery under local anaesthetic (awake)

You stay awake with the neck numbed, so the team can check your brain function during the operation. Some units prefer this; others use a general anaesthetic. Evidence does not strongly favour one over the other.

Surgery under general anaesthetic (asleep)

You are fully asleep. Monitoring of the brain's blood supply is done in other ways. The choice often comes down to your health, your wishes and the unit's usual practice.

Surgery (endarterectomy) vs stent (carotid stenting)

Point	Endarterectomy	Stenting
What it is	Open operation to remove plaque	A mesh tube placed through a tube in an artery
Stroke risk at the time	Lower for most people, especially over 70	Higher around the procedure, especially over 70
Long-term stroke prevention	Well established	Similar once the early period is past
Wound	A scar on the neck	No neck scar; small groin or wrist puncture
Usual first choice	Yes, for most symptomatic patients	Considered when surgery is higher risk or unsuitable

Trials show stenting carries a higher risk of stroke around the time of the procedure, mostly in people over 70. Surgery is the usual first choice for most people, but the right option depends on your anatomy, age and other health problems.

Preparing for your surgery

Expect the work-up to be quick if you have just had a stroke or TIA — the benefit of surgery falls the longer you wait, so it is often arranged within about 2 weeks.
You will have scans of the neck arteries (ultrasound, and sometimes CT or MRI) to confirm how narrow the artery is and which side to operate on.
Tell the team about all your medicines, especially blood thinners and antiplatelets such as aspirin or clopidogrel — most are continued, but the team will confirm.
Keep taking your statin and blood-pressure medicines unless told otherwise; good control lowers your risk around the operation.
Stop smoking as far in advance as you can — it raises the risk of stroke, wound and chest problems.
Discuss whether you would prefer to be awake (local anaesthetic) or asleep (general), and what your unit usually does.
Arrange a lift home and some help for the first days, as you should not drive for several weeks.

What happens

You lie with your head turned to one side. With either a numb neck (awake) or under general anaesthetic, the surgeon makes a cut of around 7–10 cm down the side of the neck and exposes the carotid artery.

The artery is clamped above and below the narrowing. Because blood flow to that side is briefly interrupted, the team watches closely for any change in brain function; sometimes a temporary tube (a shunt) is used to keep blood flowing past the clamps.

The artery is opened, the fatty lining is carefully peeled away, and the artery is closed — usually with a patch to keep it from re-narrowing. A small drain is often left for a day to stop swelling. The operation usually takes about 1.5–2 hours, and most people stay in hospital for one night.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

The artery is completely blocked (occluded) rather than narrowed — surgery does not usually help once it is fully blocked.
Only mild narrowing is present and you have no symptoms, where medicines alone are often safer than surgery.
You are very frail or have severe heart or lung disease that makes the risk of surgery outweigh the benefit.
A recent large, disabling stroke, where operating too soon can be more dangerous.

Delay surgery if…

You have an active infection or are acutely unwell.
Your blood pressure is poorly controlled and needs stabilising first.
You have just had a major stroke and the team advises a short wait for safety.
Key scans confirming the degree of narrowing are not yet available.

Alternatives to discuss

Best medical treatment alone — antiplatelet medicines, a statin, blood-pressure control and stopping smoking.
Carotid stenting, particularly when open surgery is judged higher risk or unsuitable.
Watchful management with medicines for mild narrowing or where symptoms are absent.
A specialist stroke-team review to confirm the narrowing is the true cause of symptoms before any procedure.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

Local anaesthetic (awake)

The neck is numbed and you stay awake, so the team can check your brain function directly during the operation. Some units prefer this approach.

General anaesthetic (asleep)

You are fully asleep, with the brain's blood supply monitored in other ways. Large trials have not shown a clear winner between awake and asleep surgery.

Benefits

Lowers the risk of a future stroke in people with a significantly narrowed neck artery
Greatest benefit for people who have recently had a stroke or TIA, when the risk of another is highest
Removes the fatty plaque that is the source of clots travelling to the brain
A long-established operation with well-understood results in the right patients
May allow blood-thinning treatment to be simplified, which your team will advise on

Risks & complications

More common

Bruising, swelling and numbness around the wound and ear, usually settling over days to weeks
A scar on the neck that fades over a few months
Temporary changes in blood pressure needing monitoring in the first day
Tiredness and a sore neck for a week or two

Less common

Injury to small nerves near the artery, causing a hoarse voice, tongue weakness or a numb patch — usually temporary but occasionally lasting
Bleeding or a neck swelling (haematoma) that can need a return to theatre
Wound infection, usually treatable with antibiotics
Heart strain or a heart attack, as many patients have heart disease too

Rare but serious

Stroke caused by the operation itself — the most important risk to understand
Death related to the operation
The artery narrowing again over time (restenosis), occasionally needing further treatment

The risk that matters most is that this stroke-prevention operation can itself cause a stroke or, rarely, death. In UK national data, about 1 in 50 people (around 2%) have a stroke or die within 30 days of carotid endarterectomy. That risk is higher if you have already had a stroke, and it is the reason the operation is only worthwhile when your risk without surgery is higher still. Ask your surgeon for their own unit's results and how they apply to your situation.

Published figures to discuss

The most important number is the risk that the operation itself causes a stroke or death. This varies with whether you have had symptoms, how recently, your age and other illnesses, and the experience of the unit. Guidelines accept surgery for symptomatic patients only when the combined stroke-and-death risk is low; for people with no symptoms the bar is stricter because the benefit is smaller. UK national figures below are averages, not a promise for any one person.

Figure	Reported range	How to interpret it	Source / confidence
Stroke or death within 30 days (UK average)	About 1.8–2.0% in recent UK National Vascular Registry reports	Roughly 1 in 50. Higher if you have already had a stroke; ask for your own unit's results.	NHS — Carotid endarterectomy: risksnhs.ukPublished figure
Stroke or death — symptomatic patients (trial data)	Around 4–6% in some series, guidelines aim for under 6%	Varies with timing after symptoms, age and surgeon experience.	NHS — Carotid endarterectomy: risksnhs.ukPublished figure
Stroke or death — patients with no symptoms	Aimed at under 3%	Benefit is smaller here, so an even lower complication rate is required to justify surgery.	NHS — Carotid endarterectomy: risksnhs.ukPublished figure
Nerve injury (hoarse voice, tongue or facial weakness)	About 1–2% recorded during admission in UK NVR reports; meta-analyses find higher early clinical nerve-injury rates, with permanent injury usually under 1%	Most recover; possible effects include hoarse voice, swallowing difficulty, tongue weakness or lower-face weakness.	NHS — Carotid endarterectomy: risksnhs.ukPublished figure

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Most people recover from the operation itself within a few weeks, but the bigger picture is lifelong: this surgery is one part of reducing stroke risk, alongside medicines and lifestyle changes.

First 24 hours

You are watched closely, often in a high-dependency area, mainly to keep blood pressure steady and to check for any signs of stroke or neck swelling. The drain usually comes out the next day.

Days 1–3

Most people go home after one night once they are stable and walking. The neck wound is closed with dissolvable stitches; a GP or nurse may check it after a few days.

Weeks 1–2

Swelling and bruising settle. Numbness around the wound and earlobe is normal and improves slowly. You can do gentle activity and short walks.

Weeks 4–6

Most people can return to driving once neck movement is comfortable and they feel safe — check the official driving rules (the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland) and your doctor's advice, especially after a stroke or TIA. Many return to non-strenuous work in this period.

6–8 weeks

A follow-up appointment checks healing and your stroke-prevention medicines. Heavy exercise and lifting are usually fine again around now.

What's normal — and not a worry

Numbness around the wound, earlobe and jaw that can take weeks or months to fade
A firm, slightly raised scar that softens and pales over time
Mild difficulty or discomfort when swallowing for a few days
Feeling more tired than expected for a week or two

Aftercare

Keep taking your antiplatelet (such as aspirin or clopidogrel) and statin every day — these are central to preventing future stroke.
Take your blood-pressure medicines as advised and attend checks; good control protects the repaired artery and your brain.
Keep the wound clean and dry; you can usually shower once it is dry and bathe after a couple of weeks.
Do not drive until your doctor and the official driving rules say it is safe — these come from the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland — this is usually several weeks and is affected by any recent stroke or TIA.
Stop smoking and get help to stay stopped — this is one of the most powerful things you can do.
Build up walking and activity gradually; avoid straining and heavy lifting in the first few weeks.
Go to your follow-up appointment and any arranged repeat scans of the artery.

Before-surgery checklist

List of current medicines, especially blood thinners and statin
Someone to drive you home and help for the first days
GP or practice nurse aware you may need a wound check
Knowledge of stroke warning signs (FAST) and when to call 999
Clinic's contact number saved for wound or swelling concerns
Smoking-cessation support arranged if you smoke

Scars and how they heal

You will have a scar of around 7–10 cm running down one side of the neck, usually following a natural skin crease so it settles discreetly. It is pink and firm at first and fades over a few months. Numbness around the scar and earlobe is common and improves slowly. Protecting the scar from strong sun in the first year helps it fade.

⚠ Get urgent help if…

Any signs of stroke — face drooping, arm weakness, slurred or lost speech: call 999 immediately (think FAST)
Sudden loss of vision, severe headache, or confusion
Rapidly increasing swelling in the neck, or difficulty breathing or swallowing — seek emergency help
Bleeding from the wound that does not stop
Increasing redness, heat, pain or discharge from the wound (possible infection)
Chest pain or breathlessness

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result is a healed neck wound and, more importantly, a lower long-term risk of stroke than if the narrowing had been left alone. Many people feel no different in themselves, because the operation is preventing a future event rather than treating a symptom.

Surgery does not remove all stroke risk. You can still have a stroke from other causes — the other side, the heart, or small vessels in the brain — which is why medicines, blood-pressure control and not smoking remain essential for life.

How long it lasts

For most people the operated artery stays open for years. A minority develop narrowing again (restenosis) over time, which is why your team may arrange occasional ultrasound scans. The benefit in stroke prevention is greatest in the first years after a warning event, and your overall risk depends heavily on how well your other risk factors — blood pressure, cholesterol, diabetes and smoking — are controlled.

Combining with other procedures

Carotid surgery is part of a wider stroke-prevention plan, not a stand-alone fix. It is normally combined with lifelong antiplatelet and statin medicines, blood-pressure treatment, diabetes control and stopping smoking. If both neck arteries are narrowed, any second operation is done separately, a few weeks apart, rather than both at once.

Follow-up & long-term care

You will usually be reviewed around 6–8 weeks after surgery to check the wound and your medicines, and some units arrange an ultrasound of the artery at intervals to look for re-narrowing. Your GP will continue to manage your blood pressure, cholesterol and other risk factors. Report any stroke symptoms straight away by calling 999 rather than waiting for a clinic appointment.

Take antiplatelet and statin medicines every day, long term
Keep blood pressure well controlled and attend monitoring
Manage diabetes carefully if you have it
Do not smoke, and seek help to stay stopped
Attend any arranged follow-up scans of the neck arteries

Revision and secondary surgery reality

The artery can narrow again over time (restenosis), occasionally needing a further procedure.
Bleeding or a neck swelling can rarely require an early return to theatre.
Surgery on the other side, if also narrowed, is done as a separate operation weeks later, not at the same time.
Stroke prevention continues for life with medicines and risk-factor control, regardless of how well the operation goes.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

Clear written stroke warning signs (FAST) and instructions to call 999, not the clinic, for any sign of stroke.
A named contact for wound, swelling or bleeding concerns in the first weeks.
A definite plan for lifelong stroke-prevention medicines and who reviews them.
Arranged follow-up and, where appropriate, repeat scans of the artery.
Active support to stop smoking and to control blood pressure and cholesterol.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

Whether the operation is urgent (after a stroke or TIA) or planned, which affects the whole pathway
Surgeon and anaesthetist fees, and whether local or general anaesthetic is used
Theatre and high-dependency monitoring time after surgery
Scans before surgery (ultrasound, CT or MRI of the neck arteries)
Length of hospital stay and any high-dependency care
Follow-up scans of the artery and ongoing stroke-prevention medicines

Make sure your written quote includes

The surgeon's and anaesthetist's fees
Hospital, theatre and high-dependency/monitoring costs
All scans before and after the operation
Follow-up appointments and any repeat artery scans
What happens — and what it costs — if a complication such as bleeding needs a return to theatre
Cancellation policy if the operation is postponed for medical reasons

On the NHS? Carotid endarterectomy is a stroke-prevention operation provided on the NHS when an artery is narrowed enough to justify it, often urgently after a stroke or TIA; it is not a cosmetic or self-pay procedure.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

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Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

How narrow is my artery, and have I had symptoms from it (a stroke or TIA)?
What is my risk of stroke without surgery, and how much would surgery lower it?
What is your unit's own 30-day stroke and death rate for this operation?
Would I be better with surgery, with a stent, or with medicines alone, given my age and health?
Will I be awake or asleep, and why do you recommend that for me?
What stroke-prevention medicines will I need afterwards, and for how long?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Is this surgery done on the NHS or privately?

Carotid endarterectomy is a treatment done on the NHS when a neck artery is narrowed enough to justify it, usually urgently after a stroke or TIA. It is not a cosmetic or self-pay procedure. Private vascular care exists, but the time-critical nature after a warning stroke means most people are treated quickly within the NHS.

Will the operation make me feel better?

Usually not directly. The aim is to lower your future risk of stroke, not to relieve a symptom. Many people feel no different afterwards, which is expected — the benefit is in the strokes prevented.

How soon after a mini-stroke should it be done?

Generally as soon as safely possible, often within about 2 weeks of symptoms, because the risk of another stroke is highest in that early period and the benefit of surgery falls the longer you wait.

Could the surgery cause a stroke?

Yes, this is the key risk. In UK national data about 1 in 50 people (around 2%) have a stroke or die within 30 days of the operation. The risk is higher if you have already had a stroke. The operation is only worthwhile when your risk without it is higher still.

What is the difference between this and a stent?

A stent is a mesh tube placed through a small tube in an artery, with no neck scar. For most people, especially those over 70, stenting carries a higher risk of stroke around the time of the procedure, so surgery is usually preferred. Stenting may be considered when surgery is higher risk or unsuitable.

When can I drive again?

Usually after several weeks, once your neck moves comfortably and you feel safe. There are specific rules after a stroke or TIA — set by the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland — so check with your doctor before driving again. If you are told you must not drive for a set time, or must notify the licensing authority, follow that advice; the rules can differ between the two authorities, so check the one that applies to you.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Carotid endarterectomy NHS — Carotid endarterectomy: risks Guy's and St Thomas' NHS — Carotid endarterectomy Circulation Foundation — Carotid artery disease National Vascular Registry — 2024 State of the Nation report National Vascular Registry — 2025 State of the Nation report Cranial nerve injury after carotid endarterectomy — meta-analysis (PubMed) ICSS — stenting vs endarterectomy (PMC) DVLA — assessing fitness to drive DVA Northern Ireland — telling DVA about a medical condition

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.