Carotid Artery Stenting vs Endarterectomy: Which Is Better for You
10/27/2025
Stroke is a serious condition that happens when a blood clot or broken vessel prevents blood from reaching the brain. Due to this, one can experience paralysis, muscle weakness, slurred speech, and memory challenges, or even seizures.
There are many causes of stroke; one major cause is carotid artery blockage. The unhealthy fatty deposits that narrow and harden the main blood vessel (carotid artery) that supplies blood to your brain. That’s why preventing stroke before it occurs is so important.
If you experience warning signs like BE FAST:
- Balance: Sudden trouble walking
- Eyes: Vision issues
- Face: One-sided facial drooping while smiling
- Arms: Weekend arms
- Speech: Slurred speech
- Time: Get medical help right away
After proper diagnosis, your doctor may recommend surgical interventions like Carotid Artery Stenting (CAS) or Carotid Endarterectomy (CEA) to restore blood flow.
Both are safe and effective; however, the best procedure is based on your age, health, and artery condition. Always listen to your doctor to make an informed decision that’s safest and most effective for you.
What is Carotid Artery Stenting
Carotid artery stenting is a minimally invasive surgical procedure. It treats carotid artery stenosis (the narrowing of the carotid arteries) to prevent possible stroke.
How Carotid Artery Stenting Lowers Stroke Risk
A healthcare provider performs the proper diagnosis with a carotid ultrasound, CT scan, or MRI. If there is a carotid artery blockage, then doctors can put in a stent (a small, metal mesh tube) to open the obstruction. Placing a stent in the carotid artery keeps it open to allow adequate blood flow to your brain. This reduces the risk of a stroke.
What is Endarterectomy?
It is a surgical procedure to treat narrowed or blocked arteries due to plaque or fatty buildup. A doctor may recommend it for conditions like peripheral artery disease or carotid artery disease.
How Endarterectomy Lowers Stroke Risk
A healthcare provider performs proper tests like Doppler ultrasound, angiography using X-rays, etc. Afterward, with the help of endarterectomy, they remove the blockages and restore the artery to its normal, healthy size.
The cleaned-out vessel can help repair leg wounds or resolve leg pain with walking or abdominal (belly) pain from insufficient circulation. This can significantly decrease the risk of stroke.
Carotid Artery Stenting vs Endarterectomy
This difference between carotid stenting and endarterectomy will help you make an informed choice with your doctor.
| Main Difference | Carotid Artery Stenting | Endarterectomy |
| Type of Procedure | Minimally invasive. A small mesh tube known as a stent is inserted via a catheter. |
Open surgery. Fatty deposits of plaque are directly removed. |
| Required Recovery Time | Shorter hospital stay because of quicker recovery time. | Longer hospital stay because of surgical incision; more recovery time is required. |
| Risk of Stroke | Stroke occurrence can be higher. Majorly in the elderly. | Lowers risk of stroke. |
| Risk of Heart Attack During Procedure | Fewer chances of a heart attack. | Slightly higher. |
| Effectiveness (Long-Term) | Both are equally good options for long-term stroke prevention. | Both are equally good options for long-term stroke prevention. |
| Eligible Candidates | People with stroke or ministroke symptoms from a carotid artery blockage (> 50%). A carotid artery obstruction of 70% or more with no symptoms. |
Symptomatic carotid stenosis of 70 percent or more (severe stenosis) Severe carotid artery disease |
| Invasiveness | Small puncture required & less invasive. | A more invasive and noticeable neck scar due to the incision. |
| Risk of Re-Narrowing | Slightly higher re-narrowing of the artery. | Lower risk of re-narrowing of the artery. |
Benefits of Carotid Artery Stenting
- A less invasive procedure
- Smaller incisions or no incision are required
- Low chances of nerve damage in the neck
- Less pain post-procedure
Benefits of Endarterectomy
- Serious complications are uncommon
- Help heal leg wounds or resolve leg pain with walking or belly pain because of poor circulation
- Significantly reduce your risk of stroke
- Results of an endarterectomy generally last for many years
Risk of Carotid Artery Stenting vs Endarterectomy
If done under trustworthy professional advice, like at Eternal Hospital, both are safe and effective. However, like other procedures, they also carry some risks.
A. Risk of Carotid Artery Stenting
- Blood clots
- Stroke
- Brain bleeding
- Bleeding at your neck incision site for TCAR
- Hypotension
- Hypertension
B. Risk of Endarterectomy
- Bleeding
- Heart problems, like a heart attack
- Infection
- Nerve damage (often temporary)
- Stroke
Who isn’t a Candidate for Carotid Artery Stenting?
The following are not eligible candidates for carotid artery stenting:
- unfavorable aortic arch anatomy
- history of severe allergic reaction to intravenous contrast dye
Who isn’t a Candidate for an Endarterectomy?
The following are not eligible candidates for endarterectomy:
- Decompensated congestive heart failure
- Recent heart attack
- Symptomatic coronary heart disease that’s not repairable
- Severe emphysema
- COPD
- Radiation damage to the area
- Infection in the area
- Massive calcification (calcium deposit in the arteries)
Is Carotid Stenting Better than Endarterectomy
Scientifically, both have shown benefits to people having the risk of stroke due to artery blockage. Your doctor will decide between carotid stenting and endarterectomy based on your health situation and requirements. Both have their unique pros and cons.
Conclusion
Whichever method your doctor chooses for you, carotid artery stenting or endarterectomy, all you need is to follow their advice. The general guidelines that you must follow for maximum benefits are:
- No heavy lifting for one week post-procedure.
- No sitting in a bath or going swimming for seven days. Showering is OK.
- Maintain a slower pace when climbing stairs.
- Do not rush to normal activities; instead, gradually increase your activities.
Call your doctor immediately if you experience unexplained:
- Chest pain
- Trouble breathing
- Fever or chills
- Numbness
- Weakness
- Swelling (edema)
- Increased discharge around the incision site
- Vision changes
- Slurring of speech
- Drooping of your face
- Nausea or vomiting