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Carotid Endarterectomy

What is a carotid endarterectomy?

Carotid endarterectomy (CEA) is a treatment for carotid artery disease. The carotid arteries are the main blood vessels that carry oxygen and blood to the brain. In carotid artery disease, these arteries become narrowed. This reduces blood flow to the brain and could cause a stroke.

For a carotid endarterectomy, your doctor will surgically remove plaque that builds up inside the carotid artery. He or she will make an incision on the side of the neck over the affected carotid artery. The artery is opened and the plaque removed. Your doctor will stitch the artery back together, restoring normal blood flow to the brain. You may have this procedure while you are awake under local anesthesia or while you are asleep under general anesthesia.

Why might I need a carotid endarterectomy?

Narrowing of the carotid arteries is most often caused by atherosclerosis. This is a buildup of plaque in the inner lining of the artery. Plaque is made up of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. Atherosclerosis, or "hardening of the arteries," can affect arteries throughout the body. Carotid artery disease is similar to coronary artery disease, in which blockages occur in the arteries of the heart, and may cause a heart attack. In the brain, it can lead to stroke.

The brain needs a constant supply of oxygen and nutrients to function. Even a brief break in blood supply can cause problems. Brain cells start to die after just a few minutes without blood or oxygen. If the narrowing of the carotid arteries becomes severe enough to block blood flow, or a piece of plaque breaks off and blocks blood flow to the brain, a stroke may occur.

You may or may not have symptoms of carotid artery disease. Plaque buildup may not be blocking enough blood flow to cause symptoms. A transient ischemic attack (TIA) or a stroke may be the first sign of disease.

Your doctor may have other reasons to recommend a carotid endarterectomy.

What are the risks of a carotid endarterectomy?

Some possible complications of carotid endarterectomy include:

  • Stroke or transient ischemic attack (TIA)
  • Heart attack
  • Pooling of blood into tissue around the incision site causing swelling
  • Nerve problems with certain functions of the eyes, nose, tongue, and/or ears
  • Bleeding into the brain (intracerebral hemorrhage)
  • Seizures (uncommon)
  • Repeated blockage of the carotid artery, or new blockage that develops in the artery on the other side of your neck
  • Bleeding
  • Infection
  • High blood pressure
  • Irregular heart beat
  • Blocked airway from swelling

If you are allergic to or sensitive to medicines, contrast dye, iodine, or latex, tell your doctor. Also tell your doctor if you have kidney failure or other kidney problems.

There may be other risks based on your condition. Be sure to discuss any concerns with your doctor before the procedure.

How do I get ready for a carotid endarterectomy?

  • Your doctor will explain the procedure to you and you can ask questions.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • Your doctor will review your health history and do a physical exam to make sure you are in otherwise good health before having the procedure. You may have blood tests or other diagnostic tests.
  • Tell your doctor if you are sensitive to or are allergic to any medicines, iodine, latex, tape, contrast dye, or anesthesia.
  • Tell your doctor of all medicines (prescription and over-the-counter) and herbal supplements that you are taking.
  • Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop some of these medicines before the procedure.
  • If you are pregnant or think you could be, tell your health care provider.
  • You will be asked to fast for 6 to 8 hours before the procedure, generally after midnight.
  • Your doctor may request a blood test before the procedure to find out how long it takes your blood to clot.
  • You may get a sedative before the procedure to help you relax.
  • Tell your doctor if you have a pacemaker.
  • If you smoke, stop smoking as soon as possible before the procedure. This may improve your recovery and your overall health status. Smoking increases clot formation in the blood.
  • Based on your condition, your doctor may ask for other preparation.

What happens during the carotid endarterectomy?

What happens after carotid endarterectomy?

Next steps

Before you agree to the test or the procedure make sure you know:
  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure