The process of carotid endarterectomy. Figure A shows a carotid artery with plaque buildup. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows how the carotid artery is cut and how the plaque is removed. Figure C shows the artery stitched up and normal blood flow restored. The inset image shows a cross-section of the artery with plaque removed and normal blood flow restored.
CEA is used to prevent stroke, or "brain attack," in people who have carotid artery disease. Carotid artery disease occurs when plaque builds up in the carotid arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows the arteries. This limits or blocks the flow of oxygen-rich blood to the brain, which can lead to a stroke.
A stroke also can occur if the plaque in an artery cracks or ruptures. Blood cells called platelets stick to the site of the injury and may clump together to form blood clots. Blood clots can partly or fully block a carotid artery.
CEA and carotid angioplasty are the two treatments used to reduce blockages in the carotid arteries.
CEA can lower the risk of stroke in people who have narrowed or blocked carotid arteries and symptoms suggesting stroke or transient ischemic attack (TIA). During a TIA, or "mini-stroke," a person may have some or all of the symptoms of stroke. However, the symptoms usually go away on their own within 24 hours.
CEA also can lower the risk of stroke in people who have severely blocked carotid arteries, even if they don't have stroke symptoms.
Carotid angioplasty is another common treatment for carotid artery disease. For this procedure, a thin tube with a balloon on the end is threaded into the narrowed or blocked artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. Usually, the doctor then places a small metal stent in the artery to reduce the risk that it will become blocked again.
Antiplatelet medicines also may be used to treat people who have carotid
artery disease. These medicines help reduce blood clotting and lower the
risk of stroke.
CEA can greatly reduce the risk of stroke in people who have carotid artery disease. The surgery is fairly safe when done by a surgeon who has experience with it. However, serious complications, such as stroke and death, can occur. People who have carotid artery disease should talk to their doctors about whether CEA is an option for them.
Individuals who have already had a CEA can take steps to lower their risk of future strokes. For example, they can get ongoing care, treat other conditions (such as high blood pressure and high blood cholesterol), and avoid smoking.
Who needs carotid endarterectomy?
A doctor may recommend carotid endarterectomy (CEA) for someone who has carotid artery disease. CEA can help prevent strokes in people who have this condition.
CEA is most helpful for people who have carotid artery disease and one or more of the following:
Other treatments for carotid artery disease
Antiplatelet medicines, such as aspirin and clopidogrel, also are used to treat people who have carotid artery disease. These medicines help reduce blood clotting and lower the risk of stroke.
A medical procedure called carotid angioplasty may be used to open blocked carotid arteries instead of CEA. For this procedure, a thin tube with a balloon on the end is threaded to the narrowed or blocked artery.
Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. Usually, the doctor then places a small metal stent in the artery to reduce the risk that it will become blocked again.
What to expect before carotid endarterectomy
Your doctor will talk to you about how to prepare for carotid endarterectomy (CEA). Before CEA, you may have one or more tests to examine your carotid arteries. These tests can show whether your arteries are narrowed or blocked, and how severe your condition is.
Carotid ultrasound uses sound waves to create pictures of the inside of your carotid arteries. A carotid ultrasound shows the structure of your carotid arteries. A Doppler carotid ultrasound shows how blood moves through your carotid arteries.
Carotid angiography is a special type of X-ray. For this test, a small tube called a catheter is put into an artery, usually in the groin (upper thigh). The tube is then threaded up into the carotid artery.
A special dye (called contrast dye) is then injected into the carotid arteries. The dye helps show blockages in the arteries and how severe they are.
Magnetic resonance angiography
Magnetic resonance angiography is a test that uses an imaging device with a large magnet and radio waves. The device makes images of the carotid arteries after they're injected with contrast dye.
Computed tomography angiography
Computed tomography angiography, or CT angiography, takes X-ray pictures of the body from many angles. A computer combines the pictures into two- and three-dimensional images. Contrast dye also is used during this test.
Other ways to prepare for carotid endarterectomy
Your doctor may ask you to fast (not eat any food) the night before the CEA. If you take prescription medicines, your doctor may tell you to change how you take them.
What to expect during carotid endarterectomy
Carotid endarterectomy (CEA) is done in a hospital. The surgery usually takes about 2 hours.
You will have anesthesia during the surgery so you don't feel pain. General anesthesia temporarily puts you to sleep. Local anesthesia numbs only certain areas of your body.
Your surgeon may choose to give you local anesthesia so he or she can talk to you during the surgery. This allows the surgeon to check your brain's reaction to the decrease in blood flow that occurs during the surgery.
During CEA, your surgeon will make an incision (cut) in your neck to expose the blocked section of the carotid artery (see diagram above). He or she will put a clamp on your artery to stop blood flow through it.
During the procedure, your brain gets blood from the carotid artery on the other side of your neck. However, your surgeon also may use a tube called a shunt to move blood around the narrowed or blocked carotid artery.
Next, your surgeon will make a cut in the blocked part of the artery. To remove the plaque, he or she will remove the inner lining of the artery where the blockage is.
Finally, your surgeon will close the artery with stitches and stop any bleeding. He or she will then close the incision in your neck.
What to expect after carotid endarterectomy
After carotid endarterectomy (CEA) surgery, you may stay in the hospital for 1 to 2 days. This allows your doctor to watch for any signs of complications.
If your surgery takes place early in the day and you're doing well, you may be able to go home the same day.
For a few days after the surgery, your neck may hurt. It also may be hard to swallow. You may want to eat soft foods that are easy to swallow until your neck isn't as sore. Your doctor may prescribe medicine to help control any pain or discomfort.
Many people are able to go back to their normal activities within about 3 weeks after having CEA. Talk to your doctor about when it's safe for you to go back to your normal routine.
After CEA, it's important to get ongoing care and treatment. Discuss your treatment needs with your doctor. Ask him or her when to schedule follow-up visits.
Talk to your doctor about when to seek emergency care. Problems that require urgent care may include:
Let your doctor know if you have questions about any of your medicines or how to take them. After the surgery, your doctor may prescribe antiplatelet medicines, such as low-dose aspirin and clopidogrel. These medicines help prevent blood clots from forming or getting larger.
As part of your long-term treatment, you can take steps to keep your carotid arteries healthy. One important step is to not smoke. Smoking can further damage your arteries. If you smoke, talk to your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
Follow your treatment plan for high blood pressure and high blood cholesterol. This can help prevent plaque buildup and blood clots in your carotid arteries.
Some people need a second CEA due to repeat plaque buildup. Following your treatment plan can help lower your chance of needing a second CEA; it also can reduce your risk of stroke.
What are the risks of carotid endarterectomy?
Serious complications from carotid endarterectomy (CEA) are uncommon, but they do occur. For example, there's a small risk of having a stroke during or after the surgery. This is because the procedure can dislodge blood clots, which may then block an artery.
There's also a small risk of brain damage, heart attack, or death. To reduce your risk, work with a surgeon who has experience with CEA.
Although uncommon, CEA also can cause less serious complications. Problems may occur during surgery, such as a bad reaction to the anesthesia, bleeding, or infection. Short-term nerve injury may cause numbness in your face or tongue. This complication usually goes away within a month.
Certain factors may raise your risk for CEA complications. For example, women are at higher risk for complications than men. Other risk factors include having diabetes or other serious medical conditions. People who are older than 75 and have other risk factors also are at higher risk.
Talk to your doctor about the risks of CEA. He or she can help you decide whether the surgery is right for you.