What is Carotid Endarterectomy (CEA)?
Carotid endarterectomy involves surgically cleaning out a blockage and then repairing one of the two carotid arteries in the neck. These arteries supply blood to the brain.
This is open surgery performed in the hospital as an inpatient procedure. It may involve general anesthesia or regional anesthesia. You may be awake and answering questions during this procedure.
The most common techniques involve either:
Patch Endarterectomy – opening the artery along the length of the exposed vessel, cleaning out the blockage with a spatula and then repairing it with a patch.
Eversion Endarterectomy – transecting the artery; everting and cleaning out the vessel by turning it inside out; and sowing it back together again without a patch.
What is the purpose of a CEA?
CEA is used when a person is at high risk of suffering a stroke due to a blockage in the carotid artery. While the procedure can help prevent stroke, the improvement in blood flow usually does NOT heal the brain from damage that has already occurred. The carotid artery can become blocked again over time and needs to be monitored.
CEA can be performed when a patient has symptoms of brain injury like a transient ischemic attack (TIA) or stroke. CEA can also be used in people who have a blockage with no change in brain function.
More About CEA
What are the Contraindications for CEA?
Prior history of severe stroke
Persons who have suffered a major devastating stroke with minimal recovery should not undergo CEA.
Carotid is 100% blocked
If the carotid artery is completely blocked, the disease likely extends into the skull base and cannot safely be removed.
Unfit for surgery
People who are very ill and otherwise unfit for surgery should not undergo CEA. Carotid stenting or medical therapy might be considered.
If people have had prior cancer of the head and/or neck and received a radical neck dissection or radiation therapy, the neck tissue might not heal well. TCAR, Transcarotid Arterial Revascularization should be considered.
More About CEA
What are the contraindications for CEA?
Prior history of severe stroke: persons who have suffered a major devastating stroke with minimal recovery should not undergo CEA.
Carotid is 100% blocked: If the carotid artery is completely blocked, the disease likely extends into the skull base and cannot safely be removed.
Unfit for surgery: People who are very ill and otherwise unfit for surgery should not undergo CEA. Carotid stenting or medical therapy might be considered.
Neck radiation: If people have had prior cancer of the head and/or neck and received a radical neck dissection or radiation therapy, the neck tissue might not heal well. TCAR, Transcarotid Arterial Revascularization should be considered.
Are there any complications to a CEA?
Stroke: CEA can, on rare occasions, cause dislodgement of the lining of the carotid artery (plaque). This can then travel into the brain leading to brain damage with either temporary or permanent injury and deficit. This risk is relatively low.
Heart attack: People with disease of the carotid artery may also have disease of the arteries on the heart. Your surgeon will usually ask if you have a history of heart disease and speak with your cardiologist to minimize the risk.
Hyperperfusion syndrome: When blood flow is reestablished, infrequently the sudden rush of blood can cause damage to the brain. The extreme pressure can cause severe headaches, confusion, blurred visions, seizures and coma.
Cranial nerve damage: is usually transient. This includes tongue deviation, hoarse voice or swallowing difficulties. This is rarely from transection of the nerve but from pressure on the nerve during exposure of the vessels. Numbness in the neck or earlobe is very common and will improve over time.
Before and After CEA
Understanding the preop evaluation
The degree of carotid stenosis can be determined in a number of ways:
Carotid ultrasound is the most common way to determine the extent of disease present in the carotid arteries. The test takes less than 30 minutes and determines a range of blockage.
CT scan imaging with contrast is a bigger test and can identify the exact place in the neck where the blockage is present.
How do I prepare for my CEA?
You will meet the Vascular Surgeon to review results of your studies and discuss why surgery is beneficial. You will discuss the specifics of the procedure along with the risks and then sit down with the scheduler to choose a date for the surgery.
You will review your medications and determine which should be held on the day of the surgery. Typically, aspirin and/or plavix are continued through the operation but blood thinners such as Xarelto, Eliquis and coumadin are held. Blood pressure medication is continued but diabetes medication is halved or held. You should ask questions about your medication list and understand your schedule for these medications.
Please alert your provider of any allergies that have affected you in the past.
CEA is performed in an operating room of a hospital. These procedures are considered inpatient involving a period of observation that usually last one to two days. Arrangements should be made for a friend or family member to drive you home when released. Although you may feel well enough to take care of yourself, you should expect a period of recovery before you are able to operate a vehicle safely.