VASCULAR SURGERY << BACK Carotid Endarterectomy Carotid artery surgery, or carotid endarterectomy, is a surgical procedure to restore adequate blood flow to the brain. The common carotid artery is located on each side of the neck. Each carotid splits into two branches -- the internal branch, which brings oxygen-rich blood to the brain, and the external branch, which brings blood to the face. Blockage of the internal carotid artery can reduce blood supply to the brain, causing a stroke. When the internal carotid arteries become blocked by fat and cholesterol build-up of atherosclerosis (also called plaque) can result. By restoring adequate blood flow to the internal carotid artery, strokes can be prevented. This may be accomplished either by endarterectomy or by angioplasty with stent placement. During the endarterectomy, the surgeon takes steps to reduce the risk of stroke from the operation. These include shunting (using a plastic tube to re-route blood flow to the brain), EEG monitoring, or even doing the operation under local anesthetic so the patient can talk to the surgeon. Usually, however, general anesthesia is used, which allows the patient to be unconscious and pain-free. After surgery, the patient is usually observed overnight to watch for any signs of bleeding, stroke, or compromised blood flow to the brain. However, the patient may be released from the hospital the same day, if the operation is done early and the patient is doing well. Erratic blood pressure (requiring monitoring in an intensive care unit) is relatively common, and tends to improve within 24 hours.