Carotid Endarterectomy

What is carotid endarterectomy (CEA)?

For some patients with carotid artery disease, the surgical removal of the plaque within the carotid artery (the artery that supplies blood to the brain) may be recommended. This procedure is called a carotid endarterectomy. Carotid endarterectomy is the most commonly performed surgical treatment for carotid artery disease.

Why is this procedure performed? Why do I need this procedure?

Carotid endarterectomy may be recommended for patients who have had a transient ischemic attack (TIA) or a stroke due to significant carotid artery disease. For these individuals, carotid endarterectomy can be highly beneficial in preventing future strokes.

CEA may also be recommended if the carotid artery has severe narrowing or blockage in the absence of the above symptoms. In this case, an individual is at risk for embolization, where debris in the area of narrowing can break off and head upstream into a blood vessel in the brain blocking the supply of oxygen to cells in the brain. To reduce this risk, CEA is done to open the artery and allow blood flow to the brain. In such instances, a stroke could occur if the patient does not receive treatment for carotid artery disease.

The decision to proceed with surgical therapy has to be made on an individual basis by the patient and his or her physician.

If a patient has a stroke, it is important to get to an Emergency Room to obtain immediate treatment.

What are the risks and potential complications of the procedure?

As with any surgery, there is a risk of complications. In the hands of an experienced surgeon, there is minimal risk for bleeding, infection, blood clots, brain damage, stroke or heart attack.

The risks of this procedure vary, depending on the severity of your carotid artery disease, location of the blockage, whether you've had a previous stroke and the presence of other coexisting medical conditions. Special precautions are taken to decrease these risks, and there may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand the risks of the procedure and why the procedure is recommended.

How do I prepare for carotid endarterectomy?

A few days before the procedure, pre-procedure tests may be performed to ensure that it is safe to perform the surgery.

You may need to discontinue certain medications before the procedure. Your healthcare team will provide specific instructions to help you prepare for the procedure. Nearly all patients will remain on aspirin through the procedure. It is important to check with your physician before stopping aspirin or Plavix if you are on these medications.

What happens during the procedure?

A carotid endarterectomy is performed either under general anesthesia (the patient is asleep) or under local anesthesia with intravenous sedation.

During a carotid endarterectomy, an incision is made in the neck, at the location of the blockage. The surgeon then makes a length-wise incision along the portion of the artery containing the plaque. The plaque is removed and in some cases, the diseased portions of the vessel are also removed.

When the plaque removal is complete, the surgeon stitches the vessel closed. Blood flow to the brain is restored through its normal path.

How long does the procedure last?

The carotid endarterectomy normally takes approximately 1 ½ to 3 hours and is extremely well- tolerated by most patients.

What happens after the procedure?

Recovery from the procedure is rapid, as most patients are discharged home the day after the procedure.

Are there any side effects of a carotid endarterectomy?

While the operation can result in some postoperative neck pain, most of this can be relieved with standard, over-the-counter pain medications, such as extra-strength acetaminophen, such as Panadol.

Results of the procedure

Your doctor will discuss the results of the procedure with you. For most people, this procedure helps prevent further brain damage and reduces the risk of stroke. However, unless patients adopt a healthier lifestyle, plaque buildup, clot formation and other problems in the carotid arteries can return.