Carotid Endarterectomy (CEA) Surgery

Carotid endarterectomy (CEA) is a type of surgery used to treat carotid stenosis. Carotid stenosis is the narrowing of one or both of the arteries leading to the head and neck. During a CEA microsurgical procedure, a UPMC neurosurgeon removes plaque blocking the carotid artery in the neck.

Treating your carotid stenosis with a carotid endarterectomy can reduce your risk of:

Stroke — A clot blocks the blood supply to part of the brain.
Second stroke — Having one stroke increases your risk of another.

What Is Carotid Endarterectomy?

UPMC surgeons use carotid endarterectomy to open narrowed carotid arteries. They also remove blockages with this procedure.

Carotid endarterectomy helps restore normal blood flow to your brain. When blood flows as it should, you are less likely to:

Have a stroke or transient ischemic attack.
Have another stroke if you've already had one.

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Why Would I Need Carotid Endarterectomy?

The carotid artery on each side of your neck carries blood to your brain and face. Over time, your carotid arteries may become blocked or narrowed by a fatty substance called plaque.

When plaque builds up in these arteries, you have carotid artery disease. Blockage or narrowing of your carotid arteries in carotid artery disease increases your risk of:

Embolic strokes — Cells in your blood stick together and form a small mass. This mass can prevent blood from flowing through a blood vessel. Pieces of a clot can also break off and travel through your blood to your brain, causing a stroke.
Transient ischemic attacks (TIA) — A blood clot or blockage interrupts blood flow to your brain. This blockage causes temporary stroke-like symptoms, including weakness, dizziness, or numbness. You might also have slurred speech, paralysis, and blindness in one or both eyes.

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Who Is A Candidate for Carotid Endarterectomy?

You may have carotid artery disease and not know it. Some people do not have symptoms even if the carotid artery narrowing is severe.

Your doctor may hear a sound called a bruit (pronounced “brewy") when they listen to your neck with a stethoscope. As the disease worsens, you may experience stroke-like symptoms.

Your doctor will discuss whether carotid endarterectomy can help protect you from a stroke. They consider:

Your age.
Your health.
Whether you've experienced any symptoms.
The size of the blockage in your artery.

Your doctor may recommend carotid endarterectomy if narrowing occurs in more than 70% of your carotid artery. They may also consider the procedure if your artery is 50% blocked and you've had stroke-like symptoms.

Alternatives to carotid endarterectomy

In some cases, doctors can use minimally invasive techniques instead of carotid endarterectomy. These approaches use tiny instruments inserted through small incisions. This avoids opening the neck or head.

Minimally invasive techniques to treat carotid stenosis include:

Surgeons can treat carotid stenosis in arteries outside the skull with carotid stenting.
For arteries within the skull, surgeons can perform percutaneous transluminal arterial angioplasty and stenting.

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What Are the Risks and Complications of Carotid Endarterectomy?

Carotid endarterectomy isn't right for everyone. Your doctor may not recommend this procedure if you have:

Advanced coronary artery disease.
Uncontrolled high blood pressure.
Heart failure.
Kidney failure.

Complications of carotid endarterectomy may occur in some people. Risks include:

Blood clots.
Brain bleeding.
Complications from anesthesia.
Heart attack or stroke.
High blood pressure or irregular heartbeat.
Infection.
Seizures.

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What Should I Expect From Carotid Endarterectomy

Your doctor will discuss whether carotid endarterectomy is right for you. Here's what to expect from this procedure.

How to prepare for carotid endarterectomy

First, your doctor explains what will happen during the carotid endarterectomy. Tell your doctor about any medications you take (including over-the-counter medicines and supplements). They may ask you to stop taking certain medications before your surgery.

On the day of your scheduled surgery, you'll arrive at the hospital and change into a hospital gown. You receive medicine so you won't feel any pain during the procedure. You may have:

General anesthesia — Medicine that makes you fall asleep completely.
Local anesthesia — Medicine that numbs only the area the surgeon is working on. You also receive medication to help you relax.

How long does carotid endarterectomy take?

Carotid endarterectomy usually takes about two hours. Specialists check your heart rate and blood pressure throughout the procedure.

During your carotid endarterectomy

During the carotid endarterectomy, the surgeon makes a small incision in your neck. They then pull back other tissues and find the carotid artery.

Your brain is monitored to make sure there is enough blood flow through the procedure. The carotid artery is clamped and opened to remove the plaque. If the brain is not receiving enough blood flow during the clamping, a flexible tube (catheter) is inserted in your neck to help blood flow around the blocked or narrow area. The catheter makes sure blood keeps flowing to your brain during surgery. The team monitors the brain activity to make sure blood flow stays consistent.

Once the artery is clear, your surgeon uses stitches to close the artery and the skin in your neck.

Recovery after carotid endarterectomy

You'll stay in a recovery area while your anesthesia wears off. Your care team continues to check your heart rate and blood pressure during this time. You'll then move to a hospital room so doctors can watch you and ensure blood flows to your brain.

After carotid endarterectomy, fluid sometimes collects near the incision. Your doctor may put a drain in your neck to empty this fluid. The drain typically stays in place for one day.

If you're healing well, you should be able to go home in a day or two. Your doctor will discuss what to expect as you recover at home.

When to call your doctor about post-op problems after carotid endarterectomy

Call your doctor right away if you have new or worsening symptoms after carotid endarterectomy.

Tell your doctor if you have:

Fever.
Chills.
Redness or swelling near your incision.
Bleeding or fluid draining from your incision.
Pain that is getting worse.

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What Are the Results of Carotid Endarterectomy?

Carotid endarterectomy can clear plaque from your carotid artery. But plaque can — and often does — return after the procedure.

To reduce the development of plaques, your doctor will suggest certain lifestyle changes. They may include:

Eating a healthy diet — less salt, fried foods, and saturated fats.
Limiting alcohol to one drink each day if you're a woman and two drinks each day if you're a man.
Not smoking. If you do smoke, try to quit.
Maintaining healthy blood pressure.
Being physically active.

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