{ "id": "epyqsm8tvk", "slug": "endarterectomy", "title": "Endarterectomy", "updated": "2026-10-15", "topic_path": [ { "id": "life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/topics/life" }, { "id": "life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health" }, { "id": "life.health.clinical", "label": "Clinical assessment and procedures", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical" }, { "id": "life.health.clinical.clinical-surgery", "label": "Surgery and surgical specialties", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-surgery" }, { "id": "life.health.clinical.clinical-surgery.vascular-and-endovascular-surgery-procedures", "label": "Vascular and endovascular surgery procedures", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-surgery.vascular-and-endovascular-surgery-procedures" } ], "geo": [ { "id": "geo.nongeo.t1946.life.health.clinical.clinical-surgery", "label": "Non-geographic · 1946 to 2000: Surgery and surgical specialties", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health.clinical.clinical-surgery", "path": [ { "id": "geo.nongeo", "label": "Non-geographic", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo" }, { "id": "geo.nongeo.t1946", "label": "Non-geographic · 1946 to 2000", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946" }, { "id": "geo.nongeo.t1946.life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life" }, { "id": "geo.nongeo.t1946.life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health" }, { "id": "geo.nongeo.t1946.life.health.clinical", "label": "Clinical assessment and procedures", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health.clinical" }, { "id": "geo.nongeo.t1946.life.health.clinical.clinical-surgery", "label": "Surgery and surgical specialties", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health.clinical.clinical-surgery" } ] } ], "excerpt": "Endarterectomy is an operation that removes atherosclerotic plaque from an artery's inner lining to restore blood flow, most often in the carotid artery to prevent stroke.", "snippet": "Endarterectomy is an operation that removes atherosclerotic plaque from an artery's inner lining to restore blood flow, most often in the carotid artery to prevent stroke.", "node": "life.health.clinical.clinical-surgery.vascular-and-endovascular-surgery-procedures", "markdown": "# Endarterectomy\n\nEndarterectomy is an operation that removes atherosclerotic plaque from the inner lining of an artery to restore blood flow and remove a source of emboli. [Carotid endarterectomy](https://www.edgepedia.org/carotid-endarterectomy) (CEA) is done to lower the risk of ischemic stroke in cerebrovascular atherosclerotic disease, and about 150,000 patients undergo it globally each year.[1](https://www.ncbi.nlm.nih.gov/books/NBK470582/) • [2](https://www.ncbi.nlm.nih.gov/sites/books/NBK441947/)\n\n| Key fact | Detail |\n|---|---|\n| What it removes | Atherosclerotic plaque from the common and/or internal carotid artery, to improve flow and remove embolic material[1](https://www.ncbi.nlm.nih.gov/books/NBK470582/) |\n| Global volume | About 150,000 CEAs per year; US use fell from 51.6 to 22.5 cases per 100,000 population between 2006 and 2020[2](https://www.ncbi.nlm.nih.gov/sites/books/NBK441947/) |\n| Symptomatic ≥70% stenosis | Absolute 17-point reduction in 2-year ipsilateral stroke risk (NASCET)[3](https://www.nejm.org/doi/full/10.1056/NEJM199108153250701) |\n| Asymptomatic ≥60% stenosis | 55% relative reduction in 5-year stroke risk (ACAS)[4](https://www.ahajournals.org/doi/10.1161/01.CIR.91.2.566) |\n| Perioperative risk limits | Combined stroke/death: 3% asymptomatic, 5% TIA, 7% prior stroke, 10% recurrent stenosis (AHA consensus)[4](https://www.ahajournals.org/doi/10.1161/01.CIR.91.2.566) |\n| Restenosis | >50% restenosis in 6–36% of patients during long-term follow-up, mostly in the first two years[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC9347312/) |\n| Timing | Ideally within two weeks of the last retinal or cerebral ischemic event for symptomatic ≥50–99% stenosis[6](https://journals.sagepub.com/doi/10.1177/23969873211012121) |\n\n## How it works\n\nThe operation exploits a natural cleavage plane in the vessel wall. The atheromatous plaque is separated from the artery by dissection in the layer between the media and the adventitia; in eversion endarterectomy the adventitia is peeled off the stationary plaque, much like peeling a glove from a hand.[7](https://digitalcardiovascularsurgery.org/uploads/project_image/carotid_endarteroctemy-66d6bb26aec22-139.pdf) • [8](https://clinicalpub.com/eversion-endarterectomy-and-special-problems-in-carotid-surgery/) [Dissection](https://www.edgepedia.org/dissection) is begun with a Cannon blade or Freer elevator in the subadventitial plane, excising the circular fibers of the media.[9](https://clinicalpub.com/technical-aspects-of-conventional-carotid-endarterectomy-for-atherosclerotic-disease/)\n\nThe distal transition from cleared vessel to remaining intima is the critical point: loose distal intima is fixed with two 7-0 polypropylene Kunlin (tacking) sutures to prevent an intimal flap from causing occlusion or embolization.[7](https://digitalcardiovascularsurgery.org/uploads/project_image/carotid_endarteroctemy-66d6bb26aec22-139.pdf) • [8](https://clinicalpub.com/eversion-endarterectomy-and-special-problems-in-carotid-surgery/)\n\nClosure matters as much as dissection. [Patch angioplasty](https://www.edgepedia.org/patch-angioplasty) (bovine pericardium, autologous vein, Dacron, or PTFE) widens the [arteriotomy](https://www.edgepedia.org/arteriotomy) and is the standard closure; a Cochrane review of 11 trials (2,304 operations) found patching reduced long-term restenosis (OR 0.24; 95% CI 0.17–0.34), perioperative arterial occlusion (0.5% vs 3.1%), and perioperative and long-term ipsilateral stroke, at low or very low certainty.[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC9347312/) • [7](https://digitalcardiovascularsurgery.org/uploads/project_image/carotid_endarteroctemy-66d6bb26aec22-139.pdf) The trade-offs of routine patching are a longer carotid occlusion time, two suture lines instead of one, and patch-material risks including early re-occlusion, arterial rupture, infection, and pseudoaneurysm formation.[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC9347312/) A 2021 systematic review of 12 RCTs found occlusion or 50–99% restenosis in 3.8% of patch versus 11.6% of primary-closure operations, but concluded a firm claim of superiority cannot yet be drawn.[10](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01692-8)\n\n## How it is done\n\nA carotid endarterectomy takes about one to two hours, through a 7–10 cm neck incision anterior to the sternocleidomastoid.[11](https://my.clevelandclinic.org/health/treatments/17312-pad-endarterectomy) • [12](https://www.ouh.nhs.uk/media/xrjh5lqt/111873endarterectomy.pdf) • [13](https://www.vascular-international.org/procedures/carotid-endarterectomy-and-patch-plasty-intraluminal-shunting) [Local anesthesia](https://www.edgepedia.org/local-anesthesia) is commonly used for CEA because it allows brain function to be monitored directly.[11](https://my.clevelandclinic.org/health/treatments/17312-pad-endarterectomy)\n\nThe main steps, in order:\n\n1. Exposure of the carotid bifurcation; heparin (75–100 IU/kg intravenously, or 70–100 units/kg to maintain an activated clotting time of 200–250 seconds) is given before clamping.[7](https://digitalcardiovascularsurgery.org/uploads/project_image/carotid_endarteroctemy-66d6bb26aec22-139.pdf) • [14](https://cdn.ymaws.com/www.svnnet.org/resource/resmgr/documents/svn_cea_guideline_final_6.12.pdf)\n2. Clamping of the internal carotid artery, the common carotid artery, and the external carotid artery (the sequence is memorized as \"ICE\").[13](https://www.vascular-international.org/procedures/carotid-endarterectomy-and-patch-plasty-intraluminal-shunting)\n3. Optional shunting. Selective shunting is indicated with contralateral carotid stenosis, impaired collateralization via the circle of Willis, or an internal carotid stump pressure below 40 mm Hg; commonly used shunts include the Javid, Sundt, and Pruitt-Inahara devices.[2](https://www.ncbi.nlm.nih.gov/sites/books/NBK441947/) • [7](https://digitalcardiovascularsurgery.org/uploads/project_image/carotid_endarteroctemy-66d6bb26aec22-139.pdf)\n4. Endarterectomy under visual control, with tacking sutures for the distal intimal flap.[13](https://www.vascular-international.org/procedures/carotid-endarterectomy-and-patch-plasty-intraluminal-shunting)\n5. Patch closure with 6-0 running polypropylene, generally omitted only when the internal carotid diameter is very large (>5 mm).[13](https://www.vascular-international.org/procedures/carotid-endarterectomy-and-patch-plasty-intraluminal-shunting) • [7](https://digitalcardiovascularsurgery.org/uploads/project_image/carotid_endarteroctemy-66d6bb26aec22-139.pdf)\n6. Declamping in reverse order (external carotid first, common carotid second, internal carotid last), then confirmation of flow by Doppler or completion angiography.[13](https://www.vascular-international.org/procedures/carotid-endarterectomy-and-patch-plasty-intraluminal-shunting) • [7](https://digitalcardiovascularsurgery.org/uploads/project_image/carotid_endarteroctemy-66d6bb26aec22-139.pdf)\n\nMost patients go home the day after surgery and avoid heavy lifting for six weeks.[12](https://www.ouh.nhs.uk/media/xrjh5lqt/111873endarterectomy.pdf)\n\n## Origin\n\nThe concept owed much to the neurologist Fischer, who recognized that carotid disease is localized and could conceivably be bypassed or locally excised; the neurologist [George Pickering](https://www.edgepedia.org/george-pickering-british-physician) then suggested to Rob and Eastcott that they correct the blockage surgically.[15](http://www.grandroundsjournal.com/articles/gr049005) The first published successful operation was reported by H.H.G. Eastcott, G.W. Pickering, and C.G. Rob in *The Lancet* in 1954, as \"Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia,\" performed at [St Mary's Hospital, London](https://www.edgepedia.org/st-marys-hospital-london), under moderate total-body-immersion hypothermia.[16](https://doi.org/10.1016/s0140-6736%2854%2990544-9) • [15](http://www.grandroundsjournal.com/articles/gr049005) Denton A. Cooley, Yousif D. Al-Naaman, and Charles A. Carton reported a temporary intra-operative shunt during carotid endarterectomy in the *Journal of Neurosurgery* in 1956.[17](https://doi.org/10.3171/jns.1956.13.5.0500)\n\nCEA became standard only after randomized trials established benefit. NASCET showed a 17-point absolute reduction in 2-year ipsilateral stroke risk for symptomatic 70–99% stenosis (26% medical vs 9% surgical, a 65% relative-risk reduction, number needed to treat 6).[3](https://www.nejm.org/doi/full/10.1056/NEJM199108153250701) ECST concordantly found a 21.2% reduction in 5-year stroke or surgical death for 70–99% stenosis without near-occlusion, but harm below 30% stenosis.[18](https://www.ahajournals.org/doi/full/10.1161/01.STR.0000054671.71777.C7) ACAS was halted in September 1994 after showing a 55% relative reduction in 5-year stroke risk for asymptomatic ≥60% stenosis.[4](https://www.ahajournals.org/doi/10.1161/01.CIR.91.2.566)\n\n## Variants\n\n**Conventional CEA** uses a longitudinal arteriotomy closed primarily or with a patch, as described above. **Eversion endarterectomy** instead transects the internal carotid artery at its origin, everts the vessel wall circumferentially around the plaque, and divides and removes the plaque; it needs no patch and has shorter clamping and operative times.[1](https://www.ncbi.nlm.nih.gov/books/NBK470582/) Lesions extending more than 2–3 cm into the internal carotid are better managed with patch angioplasty, and eversion is contraindicated after a prior conventional CEA with a prosthetic patch.[2](https://www.ncbi.nlm.nih.gov/sites/books/NBK441947/) • [8](https://clinicalpub.com/eversion-endarterectomy-and-special-problems-in-carotid-surgery/) Current evidence does not show lower perioperative stroke or restenosis for eversion, so technique should follow surgeon expertise.[14](https://cdn.ymaws.com/www.svnnet.org/resource/resmgr/documents/svn_cea_guideline_final_6.12.pdf)\n\n**Transcarotid artery revascularization (TCAR)** is a stenting approach through a short neck incision, using dynamic flow reversal: blood is drawn from the common carotid artery through sheaths and a regulated arteriovenous shunt into the femoral vein, passing an in-line filter with 200-μm pores that captures debris before the blood is returned.[19](https://www.sciencedirect.com/science/article/pii/S0741521415011477) The approach was reported in the ROADSTER multicenter trial by Christopher J. Kwolek and colleagues in 2015 in the *Journal of Vascular Surgery*; in 141 high-surgical-risk patients it achieved 1.4% overall stroke and 2.8% stroke/death.[20](https://doi.org/10.1016/j.jvs.2015.04.460) • [19](https://www.sciencedirect.com/science/article/pii/S0741521415011477)\n\n## Applications\n\nThe European Stroke Organisation guideline recommends CEA for ≥70–99% symptomatic stenosis, suggests it for 50–69% symptomatic stenosis, and recommends it for ≥60–99% asymptomatic stenosis in patients at increased stroke risk on best medical treatment.[6](https://journals.sagepub.com/doi/10.1177/23969873211012121) Timing is a major determinant of benefit: performed within two weeks of symptom onset, the number needed to treat to prevent one stroke is 5, rising to 125 beyond two weeks.[1](https://www.ncbi.nlm.nih.gov/books/NBK470582/) CEA can be deferred for a large stroke area with cerebral edema risk, contralateral carotid occlusion, or hemodynamic instability; contralateral laryngeal palsy is a relative contraindication, and prior neck radiation makes CEA technically harder.[1](https://www.ncbi.nlm.nih.gov/books/NBK470582/)\n\nEndarterectomy is also performed at other sites, including the aorta/iliac arteries, coronary arteries, femoral arteries, pulmonary arteries, and visceral arteries, with carotid endarterectomy the most common.[11](https://my.clevelandclinic.org/health/treatments/17312-pad-endarterectomy)\n\n## Limitations and alternatives\n\n**Complications.** Current patient-facing estimates are stroke 1–3%, heart attack 1–2%, nerve injury under 5%, and death about 2%.[12](https://www.ouh.nhs.uk/media/xrjh5lqt/111873endarterectomy.pdf) Cranial nerve injury can involve the hypoglossal, vagus, glossopharyngeal, or marginal mandibular branches of the facial nerve; in the CREST CEA cohort, cranial nerve injury occurred in 4.7% of patients (2% persistent at 6 months).[1](https://www.ncbi.nlm.nih.gov/books/NBK470582/) • [19](https://www.sciencedirect.com/science/article/pii/S0741521415011477) Hyperperfusion syndrome, restenosis, and recurrent TIA are recognized complications, and restenosis over 50% occurs in 6–36% of patients during long-term follow-up.[1](https://www.ncbi.nlm.nih.gov/books/NBK470582/) • [5](https://pmc.ncbi.nlm.nih.gov/articles/PMC9347312/) In NASCET, 6.7% of 1,087 surgical patients had a stroke or died within 30 days.[21](https://www.nejm.org/doi/full/10.1056/NEJM199811123392002)\n\n**Endarterectomy versus stenting.** SPACE randomized 1,200 symptomatic patients and found 30-day death or ipsilateral ischemic stroke of 6.84% with transfemoral stenting versus 6.34% with endarterectomy; stenting failed to prove non-inferiority.[22](https://www.thelancet.com/journals/lancet/article/PIIS0140673606691228/abstract) A pooled analysis of EVA-3S, SPACE, ICSS, and CREST (4,775 patients) found similar postprocedural annual ipsilateral stroke rates (0.60%/year CEA vs 0.64%/year CAS), but combined periprocedural plus postprocedural risk favored CEA by 2.8–4.1% at 1 to 9 years.[23](https://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2819%2930028-6/abstract) A meta-analysis of 8 RCTs (7,005 patients) found stenting lowered periprocedural myocardial infarction (OR 0.51) but raised periprocedural death or stroke (OR 1.76) and long-term stroke (OR 1.45), with restenosis ≥70% in 11.3% after stenting versus 8.0% after endarterectomy.[24](https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0180804) The 2021 ESO meta-analysis attributed CEA's superiority mainly to higher peri-procedural stroke after CAS, while CEA carried higher myocardial infarction and cranial-nerve-palsy risk, and peri-procedural stroke/death with CAS was higher in patients over 70.[25](https://link.springer.com/article/10.1007/s00270-024-03707-y)\n\n**What has changed since 2023.** The FDA approved TCAR for standard-surgical-risk patients in May 2022, and in October 2023 CMS expanded reimbursement for all forms of [carotid stenting](https://www.edgepedia.org/carotid-stenting), including TCAR, to standard-risk patients.[26](https://pmc.ncbi.nlm.nih.gov/articles/PMC12954140/) In a VQI cohort of 57,843 carotid revascularizations since that decision, transfemoral CAS had higher odds of perioperative stroke/death than CEA and TCAR in standard-risk patients, while in high-risk patients TCAR had lower odds than both.[27](https://www.sciencedirect.com/science/article/abs/pii/S0741521425016532) ACST-2 randomized 3,638 asymptomatic patients and found similar procedural stroke rates (1% CAS vs 2% CEA) and equal 5-year non-procedural disabling stroke (2.5% each).[25](https://link.springer.com/article/10.1007/s00270-024-03707-y) Most consequentially, a meta-analysis of SPACE-2, ECST-2, and CREST-2 (3,426 patients) found no significant difference between revascularization and medical management for stroke in asymptomatic stenosis (4.76% vs 6.40%; RR 0.91; 95% CI 0.47–1.74), with high heterogeneity, leaving the value of revascularization for asymptomatic disease an open question that is reshaping indications.[28](https://link.springer.com/article/10.1007/s00415-026-13766-5) The ESVS 2023 guideline accordingly revisits operative choices including shunting, patching, eversion versus conventional technique, and the 3% risk threshold itself.[29](https://uvecd.org.tr/dosyalar/65fabb716e889_European%20Society%20for%20Vascular%20Surgery%20%28ESVS%29%202023%20Clinical%20Practice%20Guidelines%20on%20the%20Management%20of%20Atherosclerotic%20Carotid%20and%20Vertebral%20Artery%20Disease.pdf)\n\n## References\n\n1. [Carotid Endarterectomy, StatPearls (NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/books/NBK470582/)\n2. [Carotid Artery Surgery, StatPearls (NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/sites/books/NBK441947/)\n3. [Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis (NASCET, NEJM 1991)](https://www.nejm.org/doi/full/10.1056/NEJM199108153250701)\n4. [Guidelines for Carotid Endarterectomy: AHA Multidisciplinary Consensus Statement (Circulation, 1995)](https://www.ahajournals.org/doi/10.1161/01.CIR.91.2.566)\n5. [Patch angioplasty versus primary closure for carotid endarterectomy (Cochrane Review full text)](https://pmc.ncbi.nlm.nih.gov/articles/PMC9347312/)\n6. [European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis (2021)](https://journals.sagepub.com/doi/10.1177/23969873211012121)\n7. [Atlas section: Carotid Endarterectomy operative technique](https://digitalcardiovascularsurgery.org/uploads/project_image/carotid_endarteroctemy-66d6bb26aec22-139.pdf)\n8. [Eversion Endarterectomy and Special Problems in Carotid Surgery](https://clinicalpub.com/eversion-endarterectomy-and-special-problems-in-carotid-surgery/)\n9. [Technical Aspects of Conventional Carotid Endarterectomy for Atherosclerotic Disease](https://clinicalpub.com/technical-aspects-of-conventional-carotid-endarterectomy-for-atherosclerotic-disease/)\n10. [Carotid endarterectomy with patch angioplasty versus primary closure: systematic review with meta-analyses and trial sequential analysis (Systematic Reviews, 2021)](https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01692-8)\n11. [Endarterectomy: Procedure, Types & Purpose, Cleveland Clinic](https://my.clevelandclinic.org/health/treatments/17312-pad-endarterectomy)\n12. [Carotid Endarterectomy patient information (Oxford University Hospitals, September 2025)](https://www.ouh.nhs.uk/media/xrjh5lqt/111873endarterectomy.pdf)\n13. [Carotid Endarterectomy and Patch Plasty (with Optional Intraluminal Shunting), Vascular International](https://www.vascular-international.org/procedures/carotid-endarterectomy-and-patch-plasty-intraluminal-shunting)\n14. [Society for Vascular Nursing CEA Practice Guideline](https://cdn.ymaws.com/www.svnnet.org/resource/resmgr/documents/svn_cea_guideline_final_6.12.pdf)\n15. [The epic 1954 operation that led to one of surgery's major advances: carotid endarterectomy (Grand Rounds)](http://www.grandroundsjournal.com/articles/gr049005)\n16. [RECONSTRUCTION OF INTERNAL CAROTID ARTERY IN A PATIENT WITH INTERMITTENT ATTACKS OF HEMIPLEGIA (The Lancet, 1954)](https://doi.org/10.1016/s0140-6736%2854%2990544-9)\n17. [Denton A. Cooley, Yousif D. Al-Naaman, Charles A. Carton (1956). Surgical Treatment of Arteriosclerotic Occlusion of Common Carotid Artery. Journal of neurosurgery.](https://doi.org/10.3171/jns.1956.13.5.0500)\n18. [Reanalysis of the Final Results of the European Carotid Surgery Trial (Stroke, 2003)](https://www.ahajournals.org/doi/full/10.1161/01.STR.0000054671.71777.C7)\n19. [Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal (Journal of Vascular Surgery, 2015)](https://www.sciencedirect.com/science/article/pii/S0741521415011477)\n20. [Christopher J. Kwolek and colleagues (2015). Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal. Journal of Vascular Surgery.](https://doi.org/10.1016/j.jvs.2015.04.460)\n21. [Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis (NASCET final results, NEJM 1998)](https://www.nejm.org/doi/full/10.1056/NEJM199811123392002)\n22. [30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients (Lancet 2006)](https://www.thelancet.com/journals/lancet/article/PIIS0140673606691228/abstract)\n23. [abstract (thelancet.com)](https://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2819%2930028-6/abstract)\n24. [Long-term efficacy and safety of carotid artery stenting versus endarterectomy: meta-analysis of RCTs (PLOS ONE)](https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0180804)\n25. [CIRSE Standards of Practice on Carotid Artery Stenting (2024)](https://link.springer.com/article/10.1007/s00270-024-03707-y)\n26. [Prospective, Multicenter Evaluation of TCAR in Standard-Risk Patients: 30-Day Outcomes of the ROADSTER 3 Study](https://pmc.ncbi.nlm.nih.gov/articles/PMC12954140/)\n27. [Comparative outcomes of transfemoral CAS versus CEA versus TCAR in standard- and high-risk patients since the October 2023 CMS decision (VQI; Journal of Vascular Surgery, 2026)](https://www.sciencedirect.com/science/article/abs/pii/S0741521425016532)\n28. [Medical management and revascularization for asymptomatic carotid stenosis: a meta-analysis of randomized controlled trials (Journal of Neurology, 2026)](https://link.springer.com/article/10.1007/s00415-026-13766-5)\n29. [ESVS 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease](https://uvecd.org.tr/dosyalar/65fabb716e889_European%20Society%20for%20Vascular%20Surgery%20%28ESVS%29%202023%20Clinical%20Practice%20Guidelines%20on%20the%20Management%20of%20Atherosclerotic%20Carotid%20and%20Vertebral%20Artery%20Disease.pdf)\n\n---\n*Topic: Encyclopedia › Life and health › Human health and medicine › Clinical assessment and procedures › Surgery and surgical specialties › Vascular and endovascular surgery procedures*\n\n*Initially written Sep 29, 2026 · Reviewed: Sep 30, 2026 · Edited: Oct 15, 2026 · Last review: Sep 30, 2026*\n\n*Copyright 2026 EdgeChat AI, a subsidiary of Biostate AI.*\n\nLicense: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license\n", "same_as": [], "url": "https://www.edgepedia.org/endarterectomy", "markdown_url": "https://www.edgepedia.org/endarterectomy.md", "license": { "name": "Edgepedia Community License 1.0", "url": "https://www.edgepedia.org/edgepedia/license", "summary": "Free with credit, commercial use included. AI training is open to everyone. For other uses, organizations over USD 100M in revenue or 100M monthly users license separately.", "spdx": "LicenseRef-Edgepedia-Community-1.0" }, "credit": "\"Endarterectomy\", Edgepedia (EdgeChat), https://www.edgepedia.org/endarterectomy. Edgepedia Community License 1.0.", "credit_md": "\"[Endarterectomy](https://www.edgepedia.org/endarterectomy)\", Edgepedia (EdgeChat), [https://www.edgepedia.org/endarterectomy](https://www.edgepedia.org/endarterectomy). [Edgepedia Community License 1.0](https://www.edgepedia.org/edgepedia/license).", "credit_html": "\"Endarterectomy\", Edgepedia (EdgeChat), https://www.edgepedia.org/endarterectomy. Edgepedia Community License 1.0.", "speakable": "Endarterectomy is an operation that removes atherosclerotic plaque from an artery's inner lining to restore blood flow, most often in the carotid artery to prevent stroke." }