Carotid Endarterectomy What is a carotid endarterectomy? Carotid endarterectomy (CEA) is surgery to remove built up plaque from the carotid artery in the neck. The carotid arteries carry blood from the heart to the brain. Plaque can block the arteries and cause a stroke. Why does a carotid endarterectomy need to be done? Fat and other materials can build up on the inside walls of the arteries. These deposits are called plaque. When plaque builds up on the inside walls of the carotid arteries, the inside of the arteries narrow and blood flow to the brain is reduced. A carotid endarterectomy is surgery to remove the plaque buildup that causes narrowing (stenosis) in the carotid artery. There are different tests that look at your carotid arteries to see whether they are blocked. Your doctor may first listen to the blood flow in your neck with a stethoscope. Narrowing creates a "swooshing" sound, called a bruit. If your doctor suspects narrowing, he/she will probably order more tests. Often an ultrasound is done next. This test uses sound waves to create a picture of the blood as it flows through the carotid arteries. Other imaging tests that are frequently done are computed tomography angiogram (CTA) and magnetic resonance angiogram. These tests allow the doctor to measure the plague buildup in your carotid arteries and see how well the blood is flowing through them. A blocked artery in the neck could prevent blood from reaching the brain, which could lead to a stroke. Plaque can also break off from the artery, enter the bloodstream, and become lodged in an artery in the brain. This also results in a stroke. An endarterectomy opens the clogged artery, allowing blood to reach the brain. However, because the surgery has risks, endarterectomy is not recommended for everyone with plaque build up. Your doctor may suggest endarterectomy if you have marked blockages of your arteries, had recent symptoms of a stroke or TIA (transient ischemic attacks), and are in reasonably good health otherwise. TIAs are warning signs that you could have a major stroke. How is a carotid endarterectomy performed? After you fall asleep under general anesthesia, a small cut is made in your neck. The carotid artery is cut open and the plaque is removed. Once everything is cleaned out, the artery and skin are closed with stitches. How long does the procedure take? The surgery usually takes less than an hour. Many patients go home after a few days if there are no major problems. What are the risks? The major risks from endarterectomy are that the surgery could trigger a stroke or heart attack. The chance of these problems happening is low, but possible. And many times the risk of these problems is much less than the risk of stroke if you have marked blockage. Another risk is that your arteries will become clogged up again. This is called restenosis and is most likely to occur if you continue to smoke cigarettes. Other rare complications include temporary nerve damage which can cause hoarseness, difficulty swallowing, and numbness. This problem usually clears up on its own. Bleeding and infection at the incision site and other general risks related to surgery are also possible, although rare. Sources: American Heart Association American Stroke Association National Institutes of Health (NIH) Society for Vascular Surgery
This article was reviewed and updated June 2007.
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