Carotid artery surgery

Carotid artery surgery restores the blood flow to the brain when the carotid artery is narrowed or blocked, reducing the risk of stroke. The reference intervention is carotid endarterectomy; surgery is usually considered when the artery has narrowed by more than 70%, and tests are required beforehand to check the degree of blockage.

Carotid artery surgery at a glance

• Purpose: restoring cerebral circulation and preventing stroke
• Interventions: carotid endarterectomy (by eversion or with widening angioplasty), carotid body tumour surgery
• Typical indication: carotid stenosis over 70%, a transient ischaemic attack or a previous stroke
• Prior diagnosis: imaging tests measuring the degree of blockage
• Status: one of the most frequent vascular operations

Why do the carotid arteries matter?

The carotid arteries carry oxygenated blood to the brain. When atherosclerosis narrows them, cerebral circulation drops and the risk of stroke rises — which is why carotid stenosis is considered one of the most serious cardiovascular conditions. The purpose of carotid surgery is precisely to prevent that outcome. Details about carotid disease, its symptoms and diagnosis are on the Arterial conditions page.

What is carotid endarterectomy?

Carotid endarterectomy is the surgical intervention through which the vascular surgeon removes the atheroma plaque from inside the carotid artery, preventing strokes in patients with carotid atherosclerosis. It is one of the most frequent vascular operations and represents the safest and most durable treatment of carotid disease.

Who is it recommended for?

• patients with a significant obstruction of the carotid arteries (as a rule over 70%)
• after a transient ischaemic attack (stroke symptoms lasting from 1–2 hours up to 24 hours)
• after an established stroke

The eversion technique

This involves completely sectioning the internal carotid artery at the level of the bulb and removing the atheroma plaque by eversion (turning the artery inside out, like a sock). The rest of the plaque is removed through a longitudinal arteriotomy, as in the classic technique. Both techniques deliver the same results — the choice depends on the patient’s anatomy and the surgeon’s experience.

Widening angioplasty

This involves introducing a balloon into the carotid artery to widen the narrowed areas. Most often, the procedure also involves the subsequent implantation of a carotid stent, which keeps the vessel open long term.

What is a carotid body tumour and how is it operated?

The carotid body tumour, also called a glomus tumour, is a tumour that grows on one side of the neck, where the carotid artery splits into its two branches: the internal carotid, which carries blood to the brain, and the external carotid, which supplies the areas of the face.

Usually, a carotid body tumour is not cancer. Unfortunately, however, the tumour can grow quickly and reach a large size, compressing the surrounding structures — which is why its removal through a surgical intervention is recommended.

How does the intervention work?

1. Prior embolisation (optional) — before the operation, an embolisation by direct puncture can be performed, with the main purpose of reducing the tumour’s blood supply: a special needle helps inject substances into the tumour that block the blood circulation, thus reducing intraoperative bleeding.
2. Surgical resection — the tumour is removed; as a rule, repairing the carotid arteries is not necessary.
3. Artery repair (where needed) — when repairing or removing the carotid arteries is necessary, this can be done with a simple suture.

The treatment of the carotid body tumour is safe and with excellent results for the patient.

What investigations are needed beforehand?

Tests are needed to check the degree of blockage of the artery: carotid duplex ultrasound, Doppler examination, MRI, angiography or transcranial Doppler ultrasonography. Based on the degree of stenosis and the symptoms, the doctor establishes whether an intervention is indicated and which type.

Frequently asked questions

When is carotid surgery necessary?

When imaging tests show a narrowing of over 70% of the artery, or when signs of cerebral suffering have already appeared (transient ischaemic attack, stroke). The decision is taken by the vascular surgeon together with the patient, after a complete evaluation.

Endarterectomy or stent?

Endarterectomy (including the eversion variant) is the reference treatment, the safest and most durable. Angioplasty with a stent is a useful alternative in selected cases — the decision depends on the anatomy of the lesion and on the individual risk.

What happens if carotid stenosis is not treated?

The main risk is a stroke, with the potential for permanent disability or death. Carotid stenosis is among the most serious cardiovascular conditions — which is why detecting and treating it in time is essential.

Is a carotid body tumour cancerous?

Usually not. The problem is the rapid growth and the large size it can reach, compressing the structures in the neck — which is why surgical removal is recommended, a safe intervention with excellent results.