Can you explain how a carotid surgery to remove plaque works?

Like an onion: Arteries have layers similar to onions, but only 3. The disease which causes the blockage ( atherosclerosis / plaque formation / cholesterol build-up ) involves the inner 2 layers. During surgery we expose the carotid artery, clamp above and below the blockage, open the artery up and literally separate the inner 2 diseased layers from the outer strength layer, just like layers of an onion.

Plaque removal: The inner two layers of the artery are essentially pealed out. The plaque is actually removed down to a clean plane. This removes the obstruction to the blood flow and the debris that may cause a stroke.