What Is Carotid Endarterectomy?
Carotid endarterectomy (ka-ROT-id
END-ar-ter-EK-to-me), or CEA, is surgery to remove plaque (plak) from the
carotid arteries. These are the two large arteries on each side of your neck.
They supply oxygen-rich blood to your brain.
CEA is used to prevent
stroke, or "brain attack," in people who have
carotid
artery disease. Carotid artery disease occurs when plaque builds up in the
carotid arteries.
Plaque is made up of fat, cholesterol, calcium, and
other substances found in the blood. Over time, plaque hardens and narrows the
arteries. This limits or blocks the flow of oxygen-rich blood to your brain,
which can lead to a stroke.
A stroke also can occur if the plaque in an artery
cracks or ruptures. Blood cells called platelets (PLATE-lets) stick to the site
of the injury and may clump together to form blood clots. Blood clots can
partly or fully block a carotid artery.
Overview
CEA and carotid angioplasty (AN-jee-oh-plas-tee) are
the two treatments used to reduce blockages in the carotid arteries.
CEA can lower the risk of stroke in people who have
narrowed or blocked carotid arteries and symptoms suggesting stroke or
transient ischemic attack (TIA). During a TIA, or
"mini-stroke," you may have some or all of the symptoms of stroke. However, the
symptoms usually go away on their own within 24 hours.
CEA also can lower the risk of stroke in people who
have severely blocked carotid arteries, even if they don't have stroke
symptoms.
Carotid angioplasty is another common treatment for
carotid artery disease. For this procedure, a thin tube with a balloon on the
end is threaded to the narrowed or blocked artery.
Once in place, the balloon is inflated to push the
plaque outward against the wall of the artery. Usually, the doctor then places
a small metal
stent
in the artery to reduce the risk that it will become blocked again.
Antiplatelet medicines also may be used to treat
people who have carotid artery disease. These medicines help reduce blood
clotting and lower the risk of stroke.
Outlook
CEA can greatly reduce the risk of stroke in people
who have carotid artery disease. The surgery is fairly safe when done by a
surgeon who has experience with it. However, serious complications, such as
stroke and death, can occur. If you have carotid artery disease, talk to your
doctor about whether CEA is an option for you.
If you've already had a CEA, you can take steps to
lower your risk of future strokes. For example, get ongoing care, treat other
conditions (such as
high
blood pressure and
high
blood cholesterol), and don't smoke.
Other Names for Carotid Endarterectomy
Carotid endarterectomy also is called carotid artery
surgery.
Who Needs Carotid Endarterectomy?
Your doctor may recommend carotid endarterectomy
(CEA) if you have
carotid
artery disease. CEA can help prevent
strokes in people who have this condition.
CEA is most helpful for people who have carotid
artery disease and one or more of the following:
- A prior stroke.
- A prior
transient ischemic attack (TIA), or "mini-stroke." During a
mini-stroke, you may have some or all of the symptoms of a stroke. However, the
symptoms usually go away on their own within 24 hours.
- Severely blocked carotid arteries (even if you
don't have stroke symptoms).
Other Treatments for Carotid Artery Disease
Antiplatelet medicines, such as aspirin and
clopidogrel, also are used to treat people who have carotid artery disease.
These medicines help reduce blood clotting and lower the risk of stroke.
A medical procedure called carotid angioplasty may
be used to open blocked carotid arteries instead of CEA. For this procedure, a
thin tube with a balloon on the end is threaded to the narrowed or blocked
artery.
Once in place, the balloon is inflated to push the
plaque outward against the wall of the artery. Usually, the doctor then places
a small metal stent in the artery to reduce the risk that it will become
blocked again.
What To Expect Before Carotid Endarterectomy
Your doctor will talk to you about how to prepare
for carotid endarterectomy (CEA). Before CEA, you may have one or more tests to
examine your carotid arteries.
These tests can show whether your arteries are
narrowed or blocked, and how severe your condition is.
Carotid Ultrasound
Carotid
ultrasound uses sound waves to create pictures of the inside of your
carotid arteries. A carotid ultrasound shows the structure of your carotid
arteries. A Doppler carotid ultrasound shows how blood moves through your
carotid arteries.
Carotid Angiography
Carotid angiography is a special type of x ray. For this test,
a small tube called a catheter is put into an artery, usually in the groin
(upper thigh). The tube is then threaded up into the carotid artery.
A special dye (called contrast dye) is then injected
into the carotid arteries. The dye helps show blockages in the arteries and how
severe they are.
Magnetic Resonance Angiography
Magnetic resonance angiography is a test that uses an imaging
device with a large magnet and radio waves. The device makes images of the
carotid arteries after they're injected with contrast dye.
Computed Tomography Angiography
Computed tomography (to-MOG-rah-fee) angiography, or
CT angiography, takes x-ray pictures of the body from many
angles. A computer combines the pictures into two- and three-dimensional
images. Contrast dye also is used during this test.
Other Ways To Prepare for Carotid
Endarterectomy
Your doctor may ask you to fast (not eat any food)
the night before the CEA. If you take prescription medicines, your doctor may
tell you to change how you take them.
What To Expect During Carotid Endarterectomy
Carotid endarterectomy (CEA) is done in a hospital.
The surgery usually takes about 2 hours.
You will have anesthesia (AN-es-THE-ze-a) during the
surgery so you don't feel pain. General anesthesia temporarily puts you to
sleep. Local anesthesia numbs only certain areas of your body.
Your surgeon may choose to give you local anesthesia
so he or she can talk to you during the surgery. This allows the surgeon to
check your brain's reaction to the decrease in blood flow that occurs during
the surgery.
During CEA, your surgeon will make an incision (cut)
in your neck to expose the blocked section of the carotid artery. He or she
will put a clamp on your artery to stop blood flow through it.
During the procedure, your brain gets blood from the
carotid artery on the other side of your neck. However, your surgeon also may
use a tube called a shunt to move blood around the narrowed or blocked carotid
artery.
Next, your surgeon will make a cut in the blocked
part of the artery. To remove the plaque, he or she will remove the inner
lining of the artery where the blockage is.
Finally, your surgeon will close the artery with
stitches and stop any bleeding. He or she will then close the incision in your
neck.
Carotid
Endarterectomy
The illustration shows the process
of carotid endarterectomy. Figure A shows a carotid artery with plaque buildup.
The inset image shows a cross-section of the narrowed carotid artery. Figure B
shows how the carotid artery is cut and how the plaque is removed. Figure C
shows the artery stitched up and normal blood flow restored. The inset image
shows a cross-section of the artery with plaque removed and normal blood flow
restored.
What To Expect After Carotid Endarterectomy
After carotid endarterectomy (CEA) surgery, you may
stay in the hospital for 1 to 2 days. This allows your doctor to watch for any
signs of complications.
If your surgery takes place early in the day and
you're doing well, you may be able to go home the same day.
Recovery
For a few days after the surgery, your neck may
hurt. It also may be hard to swallow. You may want to eat soft foods that are
easy to swallow until your neck isn't as sore. Your doctor may prescribe
medicine to help control any pain or discomfort.
Many people are able to go back to their normal
activities within about 3 weeks after having CEA. Talk to your doctor about
when it's safe for you to go back to your normal routine.
Ongoing Care
After CEA, it's important to get ongoing care and
treatment. Discuss your treatment needs with your doctor. Ask him or her when
to schedule followup visits.
Talk to your doctor about when to seek emergency
care. Problems that require urgent care may include:
- Severe headaches.
- Swelling in the neck.
- Signs or symptoms of
stroke or
transient ischemic attack (TIA, or mini-stroke).
Signs and symptoms may include sudden weakness or numbness in the face or
limbs; the inability to move one or more of your limbs; trouble speaking,
understanding, or seeing in one or both eyes; and dizziness or loss of
balance.
Let your doctor know if you have questions about any
of your medicines or how to take them. After the surgery, your doctor may
prescribe antiplatelet medicines, such as low-dose aspirin and clopidogrel.
These medicines help prevent blood clots from forming or getting larger.
As part of your long-term treatment, you can take
steps to keep your carotid arteries healthy. One important step is to not
smoke. Smoking can further damage your arteries. If you smoke, talk to your
doctor about programs and products that can help you quit. Also, try to avoid
secondhand smoke.
Follow your treatment plan for
high
blood pressure and
high
blood cholesterol. This can help prevent plaque buildup and blood clots in
your carotid arteries.
Some people need a second CEA due to repeat plaque
buildup. Following your treatment plan can help lower your chance of needing a
second CEA; it also can reduce your risk of stroke.
What Are the Risks of Carotid Endarterectomy?
Serious complications from carotid endarterectomy
(CEA) are uncommon, but they do occur. For example, there's a small risk of
having a
stroke during or after the surgery. This is because the
procedure can dislodge blood clots, which may then block an artery.
There's also a small risk of brain damage,
heart
attack, or death. To reduce your risk, work with a surgeon who has
experience with CEA.
Although uncommon, CEA also can cause less serious
complications. Problems may occur during surgery, such as a bad reaction to the
anesthesia, bleeding, or infection. Short-term nerve injury may cause numbness
in your face or tongue. This complication usually goes away within a month.
Certain factors may raise your risk for CEA
complications. For example, women are at higher risk for complications than
men. Other risk factors include having diabetes or other serious medical
conditions. People who are older than 75 and have other risk factors also are
at higher risk.
Talk to your doctor about the risks of CEA. He or
she can help you decide whether the surgery is right for you.
Key Points
- Carotid endarterectomy (CEA) is surgery to remove
plaque from the carotid arteries. These arteries supply oxygen-rich blood to
your brain.
- CEA is used to prevent
stroke in people who have
carotid
artery disease. Carotid artery disease occurs when plaque builds up in the
carotid arteries. Over time, plaque hardens and narrows the arteries. This
limits or blocks the flow of oxygen-rich blood to your brain, which can lead to
a stroke.
- CEA is most helpful for people who have carotid
artery disease and one or more of the following:
- A prior stroke.
- A prior
transient ischemic attack (TIA), or "mini-stroke." During a
mini-stroke, you may have some or all of the symptoms of stroke. However, the
symptoms usually go away on their own within 24 hours.
- Severely blocked carotid arteries (even if
you don't have stroke symptoms).
- Other treatments, such as carotid angioplasty and
medicines, also are used to treat carotid artery disease.
- Your doctor will talk to you about how to prepare
for CEA. Before the procedure, you may have one or more tests to examine your
carotid arteries. These tests can show whether your arteries are narrowed or
blocked, and how severe your condition is.
- CEA is done in a hospital. The surgery usually
takes about 2 hours. You will have anesthesia during the surgery so you don't
feel any pain.
- During CEA, your surgeon will make an incision
(cut) in your neck to expose the blocked section of the carotid artery. He or
she will then make a cut in the artery and remove the plaque inside. Finally,
your surgeon will close the artery with stitches and stop any bleeding. He or
she will then close the incision in your neck.
- After CEA, you may stay in the hospital for 1 to
2 days. This allows your doctor to watch for any signs of complications. Many
people are able to go back to their normal activities within about 3 weeks
after having CEA.
- After CEA, it's important to get ongoing care and
treatment. Discuss your treatment needs with your doctor. Ask him or her when
to schedule followup visits.
- As part of your long-term treatment, you can take
steps to keep your carotid arteries healthy. For example, don't smoke. Treat
other conditions, such as
high
blood pressure and
high
blood cholesterol.
- Following your treatment plan can help lower your
chance of needing a second CEA; it also can reduce your risk of stroke.
- Serious complications from CEA are uncommon, but
they do occur. For example, there's a small risk of having a stroke during or
after the surgery. There's also a small risk of brain damage,
heart
attack, or death. Talk to your doctor about the risks of CEA. He or she can
help you decide whether the surgery is right for you.
Links to Other Information About Carotid
Endarterectomy
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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