In a carotid endarterectomy, atherosclerotic plaque that has built up on the inside of the carotid artery wall is surgically removed. An incision is made on the side of the neck where the affected carotid artery is located. Under direct visualization, the artery is opened and the plaque removed. The artery is sutured back together, restoring normal blood flow to the brain. This procedure may be performed while a patient remains awake under local anesthesia or while the patient is asleep under general anesthesia.