What is a Carotid Endarterectomy?

J.M. Willhite

A carotid endarterectomy (CEA), also known commonly as carotid artery surgery, is a medical procedure utilized to remove arterial blockages and restore proper blood flow to an individual’s brain. Plaque-induced blockages of the carotid artery may contribute to an individual’s risk for stroke, though the person may be asymptomatic, meaning he or she is not experiencing any symptoms. As with any invasive surgical procedure, there are risks associated with a carotid endarterectomy and these should be discussed with a qualified health care professional prior to scheduling surgery.

Surgery may be required to remove arterial blockages in the carotid artery to that disrupt blood flow to the brain.
Surgery may be required to remove arterial blockages in the carotid artery to that disrupt blood flow to the brain.

The carotid artery is a main blood pathway located on either side of an individual’s neck that provides blood to the brain. Over time, plaque may build up within the artery, causing either a partial or complete blockage that restricts blood flow. Composed of fatty material, plaque may accumulate within the artery without immediately inducing symptoms. Reduced blood flow may result in the formation of a blood clot, known as a thrombus, that may block the artery and further restrict blood flow in the already narrowed passage. When a blockage progresses to completely limit blood flow, an individual is at the greatest risk for stroke or death.

The carotid artery, which supplies oxygenated blood to the brain, can potentially develop stenosis.
The carotid artery, which supplies oxygenated blood to the brain, can potentially develop stenosis.

Someone with a carotid arterial blockage may experience symptoms similar to those associated with a stroke, including impaired vision, slurred speech, or confusion. Asymptomatic individuals whose arterial blockage is discovered during a physical examination may exhibit a bruit, or abnormal sound associated with impaired arterial blood flow. In the event a bruit is discovered, additional testing may be ordered to further evaluate the condition of the individual’s carotid arteries.

Once an arterial blockage has been confirmed, a further assessment of the individual’s overall condition is performed to determine if a carotid endarterectomy is appropriate. Individuals who have had a stroke and are of advanced age and in ill health may not be good candidates for CEA surgery, especially if the risk of another stroke or post-operative complications is significant. If surgery is determined to be an appropriate treatment option, the physician may evaluate which CEA approach is necessary to successfully remove the blockage.

Carotid endarterectomy may be conducted in one of two ways: invasively through the neck or less invasively through the groin with the application of stenting. A carotid endarterectomy conducted through an incision made in the neck is generally reserved for individuals in overall good health with mild to severe blockage. Those for whom the first approach may be too risky may undergo what is known as carotid angioplasty and stenting.

Conducted under generally anesthesia, a CEA involves the placement of a catheter into an incision made in the neck so blood flow may be rerouted during the procedure. As the individual’s heart and brain activity are monitored, the artery is opened and the plaque creating the blockage is removed. Once the blockage is excised, the artery is stitched closed and blood flow is restored to the mended passage.

A local anesthetic and mild sedative may be administered to those who undergo a carotid angioplasty and stenting procedure. After an incision is made in the groin area, a catheter, known as a guide wire, is inserted into the opening and directed to the neck area with the assistance of imaging technology. Performed with the help of fluoroscopy, or live X-ray, a second catheter outfitted with a small balloon is inserted and led to the blockage. Upon reaching the affected area, the balloon is inflated to press the accumulated plaque against the artery walls and restore blood flow. Once a small tube composed of mesh-like wire material, known as a stent, is placed in the passage to ensure the artery remains open, the balloon is deflated and removed.

Prior to surgery, the individual may be asked to temporarily discontinue any medications that may adversely affect blood clotting. Following the procedure, the individual may remain hospitalized for at least 24 hours so his or her condition may be monitored and any fluid accumulation in the affected area may be drained. Lifestyle and dietary changes may be necessary to prevent blockage recurrence, including smoking cessation and adopting a diet geared toward reducing one’s cholesterol. Risks associated with a CEA may include heart attack, brain damage, and excessive bleeding. Additional risks may include infection, respiratory difficulty, and blockage recurrence.

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