Prof. Dr. Ali Serdar Fak
Cardiac SurgeryVerified
- 29+years exp.
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Vascular Surgery
Carotid endarterectomy
What carotid endarterectomy is, how a surgeon removes plaque from the carotid artery through a neck incision, what the NASCET, ECST and ACST trials show, when surgery is preferred to stenting or medicines, approximate costs in Turkey against the UK, US and Germany, hospital stay, recovery, nerve and stroke risks and how timing affects travel.
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Dr. Bülent İlçöl
Cardiac SurgeryVerified
- 25+years exp.
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Carotid endarterectomy in Turkey: what it is and how it works
Carotid endarterectomy (CEA) is an operation to remove fatty plaque from the inside wall of a carotid artery in the neck. The carotid arteries supply the brain; plaque (atherosclerosis) narrows the vessel and can release fragments or clots that cause a stroke or a transient ischaemic attack (TIA). In the operation a vascular surgeon opens the artery, peels out the plaque together with the diseased lining, and closes the artery, usually with a patch, so that blood flows freely again. It is one of the longest-established operations for stroke prevention, and vascular surgery departments in Turkey carry it out for suitable patients.
This guide explains the operation step by step, what the major trials show, when surgery is chosen over stenting or medicines, the approximate cost compared with the UK, US and Germany, recovery and risks. It also explains why timing after a TIA or stroke matters before you consider travel. Other vessel and heart services are in our cardiology treatments in Turkey hub.
Does carotid endarterectomy prevent stroke? What the trials found
Yes, for the right patients. The NASCET and ECST trials showed that for people who had recent symptoms (a TIA or a minor stroke on the same side) and a severe narrowing of the artery, surgery plus medicines greatly reduced the chance of a further stroke compared with medicines alone, and the benefit is largest when the operation is done within about two weeks of the event. For people with a narrowing but no symptoms, trials such as ACST-1 showed a reduction in stroke over several years, but medical treatment has improved since and the benefit is smaller and is debated, particularly for older patients or those with a short life expectancy. For that reason guidelines from the European Society for Vascular Surgery, the American Heart Association and NICE recommend that the choice is made by a team on an individual basis.
Who needs carotid endarterectomy, and who should not travel?
Surgery is usually advised when a narrowing of roughly 50 to 70 percent or more has caused a TIA or a minor stroke, and, more selectively, in someone without symptoms who has a severe narrowing and good general health. You are less suited if the artery is completely blocked, the brain damage from a stroke is very large, a heart or lung condition makes anaesthesia unsafe, or the narrowing sits very high in the neck. If you have had a TIA or stroke in the past few days or two weeks, treatment is time-sensitive and you should be assessed by a stroke service close to home; do not wait for a trip. Call emergency services for sudden face droop, arm weakness or trouble speaking.
How is the operation done, step by step?
The operation lasts about one and a half to two and a half hours. The usual steps are these:
- Anaesthesia: general anaesthesia, or a regional neck block with the patient awake so that speech and movement can be tested.
- Incision: a cut along the front of the neck, or a shorter oblique one for an eversion technique, exposes the artery.
- Clamping and shunting: the artery is clamped above and below the narrowing; a temporary tube (shunt) may carry blood to the brain meanwhile, and brain monitoring may be used.
- Plaque removal: the artery is opened, the plaque is removed and the lining is smoothed.
- Closure: the artery is closed with a patch, or by eversion, and the neck wound is sewn with a small drain sometimes left in.
Patients are watched in a recovery or high-dependency unit while the team checks the face, speech, arm and leg strength, and blood pressure, which must be kept in a narrow range.
Carotid endarterectomy cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for a planned operation with imaging and a hospital stay, not hospital quotes. The price depends on the anaesthesia, the closure technique and use of a patch, the nights in a high-dependency unit and the scans needed. Each hospital confirms its own price in a written quote after seeing your reports.
| Country | Approximate cost range |
|---|---|
| Turkey | €4,500 – €11,000 |
| United Kingdom | €9,000 – €23,000 |
| United States | €20,000 – €58,000 |
| Germany | €9,000 – €23,000 |
What changes the carotid endarterectomy price: one side or both, a regional or general anaesthetic, a shunt or monitoring, the grade of room and any extra days if a complication occurs. A package usually covers the pre-operative scans and tests, the surgeon, anaesthetist and theatre, the nights in hospital, discharge medicines and transfers; ask whether a follow-up duplex scan and treatment of a complication are included.
Endarterectomy, stenting or medicines alone: which fits which patient?
The alternatives treat the same narrowing in different ways. Stenting uses a catheter rather than a neck incision, while medicines (antiplatelet tablets, statins, blood-pressure control) are part of every plan. In large trials the early stroke risk was higher with stenting in patients over about 70, while younger patients did about as well with either; the heart-attack and nerve-injury risks lean the other way.
| Option | Best suited to | Typical limits |
|---|---|---|
| Carotid endarterectomy | Symptomatic severe narrowing, older patients, most neck anatomies | Neck wound; nerve injury; anaesthetic and heart risk |
| Carotid stenting | Previous neck radiotherapy or surgery, high lesions, high operative risk | Higher early stroke risk in older patients; antiplatelet tablets |
| Medicines alone | Narrowing without symptoms, selected patients | Does not remove the narrowing |
Your trip to Turkey and carotid endarterectomy recovery
Most patients stay in hospital one to three nights, and should plan five to eight days in Turkey in total for the assessment, the operation and a duplex scan and wound check before flying. The neck is swollen, bruised and sore for the first one or two weeks, and a hoarse voice, a numb patch under the jaw or an ear and a sore throat are common because the tube and the nerve branches around the artery are disturbed. You walk the next day. Driving and desk work are generally resumed after about two weeks, and lifting heavy loads after four to six weeks. The surgeon decides when flying is safe, usually after about a week if there is no bleeding or neurological symptom. Antiplatelet tablets and a statin continue for life, with check scans at about one month and then yearly.
Risks of carotid endarterectomy: stroke, nerves and bleeding
The NHS and the American Stroke Association describe the risks. The most serious are stroke or death around the time of the operation, which guidelines expect to be low in specialist units, and heart attack in patients with heart disease. Other risks are bleeding or a haematoma in the neck that can press on the airway and needs urgent return to theatre, injury to the nerves of the face, tongue, voice box and swallowing (most recover over weeks or months), wound infection, high or low blood pressure and re-narrowing of the artery later. Ask the surgeon for the unit's own results rather than a general figure.
Are vein treatments for the legs part of this?
No. Carotid surgery treats an artery that feeds the brain. Procedures such as sclerotherapy of varicose veins, laser treatment for varicose veins and EVLA endovenous laser ablation are performed on leg veins and are unrelated in purpose and risk. A vascular surgeon may treat both groups, but the assessments and the planning are separate.
How to choose a vascular surgery team, and questions to ask
Check that the surgeon is a specialist in cardiovascular or vascular surgery registered in Turkey, that the hospital is licensed with intensive-care support, a stroke or neurology service and a blood bank, and that you get a written plan and price after the team has seen your scans. Red flags include a quote without imaging, surgery proposed without discussing stenting or medicines, pressure to fly soon after a recent stroke, and no figures for the unit's stroke and death rates. Read how it works and ask:
- Why endarterectomy rather than stenting in my case?
- Will you use a patch, a shunt or brain monitoring?
- How many carotid operations does the unit do each year, and what are its 30-day stroke and death rates?
- What nerve problems should I expect, and how long do they last?
- Who reviews my scans and medicines when I am home?
To start, request a plan through our free quote page and send your scan reports.
Hospitals with Cardiac Surgery in Turkey
Frequently asked questions
It is an operation in which a surgeon opens the carotid artery in the neck, removes the fatty plaque and closes the vessel, often with a patch. The aim is to prevent a stroke by restoring blood flow and removing a source of clots.
For people with recent symptoms and a severe narrowing, trials show it substantially lowers the chance of another stroke, mostly when done within about two weeks. For people without symptoms the benefit is smaller and is debated.
Approximate prices run from €4,500 to €11,000 in Turkey, against about €9,000 to €23,000 in the UK. The anaesthesia, closure method, room and extra nights change the price, and the hospital confirms it in a written quote.
Most people stay one to three nights, feel neck soreness for one or two weeks and return to desk work and driving after about two weeks. Lifting heavy loads is postponed for four to six weeks.
You are asleep or have a numbed neck during surgery. Afterwards the neck is sore and swollen and may feel numb near the incision, usually controlled with simple painkillers and easing over a couple of weeks.
Neither is safer for everyone. In older patients trials found fewer early strokes with surgery, while stenting suits some who are at high surgical risk. A vascular team should explain which suits your case.
The main risks are stroke, heart attack, neck bleeding, injury to nerves of the face, tongue and voice, infection and re-narrowing. Ask the surgeon for the unit's own stroke and death figures.
Treatment is time-sensitive after a recent TIA or stroke, so you should first be assessed by a local stroke service. Planned travel suits patients who are stable and have no recent symptoms.
Plan five to eight days: assessment, one to three nights in hospital and a scan and wound check before you fly. A complication or a staged operation on both sides can lengthen the stay.
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