Narrowed carotid arteries are among the most significant risk factors for stroke. Carotid surgery, meaning an operation on these vessels, can significantly reduce this risk. In this article, you will learn when and why this surgery is advisable, what procedures are available, and what you should keep in mind after the operation. You will also find selected specialists for carotid surgery here.
Carotid surgery, or a carotid operation, is a procedure on the carotid artery (medically: arteria carotis) in which a narrowing of the vessel is corrected. The goal is to prevent strokes caused by the accelerated and turbulent blood flow through the narrowed segment.
The carotid artery carries oxygen-rich blood from the heart to the brain. Over the years, fat, calcium, or blood clots can accumulate on the vessel wall — so-called plaques — leading to a narrowing (stenosis). In severe cases, a stroke can occur if parts of these deposits break off and travel to the brain.
Carotid surgery is a subfield of vascular surgery, which is a specialized branch of surgery on blood vessels.
A carotid stenosis, or narrowing of the carotid artery, often goes unnoticed for a long time. Many affected individuals have no symptoms — yet the risk of stroke is significantly increased. Treatment is especially recommended:
The goal of carotid surgery is to significantly reduce the risk of a recurrent or initial stroke and to ensure long-term blood supply to the brain.
Carotid surgery can be performed in two ways:
In this method, the carotid artery is surgically opened. The surgeon removes the deposits (plaques) on the vessel wall. The artery is then closed with fine sutures or a patch (a vascular graft made from synthetic or autologous material).
Alternatively, the plaques can be removed by severing the internal carotid artery from the common carotid artery, removing the plaque with a special instrument, and then reattaching the internal carotid artery to the common carotid artery using sutures.
In this approach, a metal mesh (stent) is inserted into the narrowed vessel. It keeps the artery open from the inside. The procedure is minimally invasive, usually performed through an access point in the groin.
Important to know:
Open surgical treatment is usually performed under general anesthesia but can also be done under local anesthesia at the patient’s request. Carotid stenting is performed via the femoral artery under local anesthesia. Both procedures take approximately one to two hours.
After surgical or endovascular carotid treatment, the patient usually remains for 1 day in a monitoring unit. Full discharge typically occurs within 2 to 5 days.
Postoperative follow-up care is crucial:
The success of the treatment largely depends on how strictly these recommendations are followed.
As with any surgical procedure, the treatment of carotid stenosis involves potential risks. The most common include:
Given that these risks, although rare, cannot be completely ruled out, the decision to operate or to perform stenting (indication) is clearly based on the guidelines of the European and German professional societies. In any case, the stroke risk following treatment should be lower than the risk of stroke under medication-only therapy. Especially in patients who have already experienced a stroke, surgery significantly reduces the risk of another stroke.
The long-term prognosis after carotid surgery is very good for most patients. Studies show that the risk of stroke can be reduced by up to 60% through the procedure. The best outcomes are seen in patients who consistently manage their risk factors and adhere to medical follow-up recommendations.
When a narrowing of the carotid artery is diagnosed, carotid surgery can be a vital measure to prevent a stroke. The procedure is now safe and effective, especially when detected early. It is essential to consult an experienced vascular surgeon and to take follow-up care seriously. This can significantly reduce the risk of severe complications.
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