Carotid artery surgery prevents stroke by addressing blockages in the carotid arteries, the main blood vessels supplying oxygenated blood to the brain. These blockages, caused by a buildup of fatty plaque, can severely restrict blood flow or cause fragments to break off and travel to the brain. Specialists primarily use two approaches: Carotid Endarterectomy (CEA), a traditional open surgical method, and Carotid Artery Stenting (CAS), a less invasive, endovascular technique. The choice depends on the patient’s overall health, the artery’s anatomy, and the specific characteristics of the plaque buildup.
The Duration of the Procedure
The actual time spent in the operating room or catheterization lab is relatively short, though it varies between the two main types of intervention. A Carotid Endarterectomy generally takes about one to two hours to complete. This timeframe includes accessing the artery, temporarily shunting blood flow if necessary, removing the plaque, and then closing the artery and the neck incision.
Carotid Artery Stenting, the minimally invasive option, often has a similar procedural duration, typically lasting between one and two hours. While the stenting itself may be quicker, the preparation, including antiplatelet medications and detailed imaging guidance, can add considerable time to the overall process. These durations do not include the time required for pre-anesthesia preparation or immediate post-procedure observation in the recovery unit.
Variables That Affect Surgical Time
Surgical times are ranges because several patient-specific and procedural factors influence the duration. A primary variable is the complexity and location of the plaque (stenosis), particularly if the blockage extends high into the skull base or is calcified. A highly winding artery also makes the navigation of tools during a CAS procedure more time-consuming.
The type of anesthesia used also plays a role, as CEA can be performed under local or general anesthesia. If local anesthesia is used, the surgical team may periodically monitor the patient’s neurological function, which can influence the operation’s flow. For CEA, the decision to use an internal shunt—a temporary tube to reroute blood flow—adds a few minutes to the procedure. Unexpected anatomical variations or the need to manage minor bleeding can also extend the operating time.
The Total Hospital Stay
The total hospital stay is a broader measure, encompassing pre-operative preparation, the procedure itself, and post-operative monitoring, which is distinct from the surgical time. Pre-operative preparation begins upon admission and involves final blood work, imaging, and a detailed discussion with the surgical and anesthesia teams, often taking several hours. Following the procedure, patients are moved to a specialized unit for close observation, where blood pressure and neurological status are monitored frequently to prevent complications.
For a Carotid Endarterectomy, the institutional stay is typically one to two nights (24 to 48 hours) to ensure stability before discharge. Patients undergoing Carotid Artery Stenting sometimes have a shorter stay, with many discharged after just one night or even within 23 hours. The goal of this in-hospital period is to manage blood pressure fluctuations and identify any immediate post-procedural issues, such as localized nerve weakness or bleeding at the incision site.
Post-Discharge Recovery Milestones
After leaving the hospital, the patient begins functional recovery, focusing on a gradual return to normal life. Most individuals can resume light activities of daily living, such as walking and self-care, within the first one to two weeks following the procedure. During this initial period, neck discomfort and soreness near the incision are common, which usually subsides within a couple of weeks.
Restrictions on driving are typically in place until the neck is pain-free and flexible enough to safely turn the head, which often takes about two weeks. For those with desk jobs, returning to work can happen within one to two weeks. Individuals with more strenuous occupations may need to wait four to six weeks. Full recovery, meaning the incision is completely healed and the patient feels entirely back to their pre-operative energy level, is generally achieved within four to six weeks.