Carotid endarterectomy - When it's needed (2024)

A carotid endarterectomy may be needed if one or both of your carotid arteries become narrowed because of a build-up of fatty deposits (plaque).

This is known as carotid arterydisease or carotid artery stenosis, and it significantly increases your risk of havinga stroke or transient ischaemic attack (TIA).

Why carotid artery disease develops

Normal healthy arteries are elastic and smooth on the inside, allowing blood to easily flow through them.

As a person gets older, plaque can build up inside the arteries, making them narrower and stiffer. This process is called atherosclerosis.

As well as ageing, there are several other factors that can contribute to a build-up of plaque.

These include:

• a high-fat diet
• high blood pressure (hypertension)
• diabetes
• smoking

Carotid artery diseaseand stroke

There are 2 ways a stroke or TIA could occur if the flow of blood through yourcarotid arteries becomes blocked or restricted:

• an ischaemic stroke – if the carotid artery is completely blockedand limits the blood supply toyour brain
• an embolic stroke– if ablood clot forms on the roughened surface of the carotid artery and breaks off, it may block 1 or more arteries in the brain

Diagnosing carotid artery disease

Carotid artery disease is usually diagnosed if a person has the symptoms of a stroke or TIA, such asthe face drooping on 1 side, numbness or weakness inthe arms or legs, speech problems, or a loss of vision in 1 eye.

Sometimes it's diagnosed if you're having tests for another reason and the doctor testing you notices your arteries are narrowed.This is called an asymptomatic carotid stenosis.

If you recentlyhad a stroke or TIA, you'll be referred for some brain imaging tests. This allowsthe blood supply to your brain to be checked and any narrowing in your carotid arteries to be diagnosed.

Severalimaging testscan beused to see how much plaque has built up inside your carotid arteries.

These include:

• a duplex ultrasound scan– sound waves are used to produce an image of your blood vessels and measure the blood flow through them;it can also show how narrow your blood vessels are
• a CT scan – a series of X-raysare takenat slightly different angles, anda computer assembles the images to create a detailed picture of the inside of your body
• a computed tomographic angiogram (CTA) – a special dye is injected into a veinand a CT machine is used to take X-raysto build up a picture of your neck arteries
• a magnetic resonance angiography (MRA) – a magnetic field and radio waves are used to produce images of your arteries and the blood flow within them

You'll usually have an ultrasound scan first to checkif there's any narrowing inyour arteries and determine whether it's severe enoughfor you to benefit from having surgery.

If your arteries are narrowed, you may need to have further tests to confirm the diagnosis, such as aCTA or MRA.

Grading narrowed arteries

If tests indicate your carotid arteries are narrowed, theseverity of the narrowing (stenosis) will be graded to determine whether you need surgery.

In the UK, the North American Symptomatic Carotid Endarterectomy Trial (NASCET) scale is the most common grading system used.

The scale has 3 categories:

• minor– 0 to 49% narrowed
• moderate– 50 to 69%narrowed
• severe – 70 to 99% blocked

When is surgery recommended?

The National Institutefor Health andCare Excellence (NICE) recommends that people who have had a stroke or TIA and have a moderate or severe stenosis should have a carotid endarterectomy.

You should be assessed within a week of the start of your stroke or TIA symptoms.

The operation will ideally be carried out within 2 weeks of when your symptoms started.

It's crucial to get medical advice as soon as possible if you develop the symptoms of a stroke or TIA.

Having surgery gives the best chance of preventing a furtherstroke if it's performed as soon as possible.

Surgery is sometimes recommended for people who haven't previously had a stroke or a TIA but are found to have severe stenosis.

Surgery isn't recommended in cases where there's minor stenosis (less than 50%).

This is because surgery is most beneficial for people with moderate and severestenosis (more than50%).

The maximum benefitis seen in those with severe stenosis (70 to 99%).

A carotid endarterectomy isn't of any benefit for people witha complete blockage of their carotid artery.