Overview & Description
Carotid endarterectomy (CEA) is a procedure used to remove a blockage in thecarotid artery to prevent a strokefrom occurring. The carotid arteries are blood vessels located in the neck thatsupply blood to the brain. There is one carotid artery on each side of theneck. When these vessels become narrowed or blocked, blood flow to the brain isreduced. This can lead to a stroke.
Who is a candidate for the procedure?
Many people develop fatty deposits on the insides of their arteries as theygrow older. This is known as atherosclerosis. If the deposits become toobig in the carotid arteries, people are at risk for a stroke. Thosewho have a high degree of blockage in the carotid arteries are at the highestrisk for a stroke. These are the people who benefit from a carotidendarterectomy.
People with lower amounts of blockage are only offered a carotid endarterectomyunder special circumstances. For example, if a person is having symptoms froma blocked artery even though the blockage is only moderate, he or she may be acandidate for this procedure. Symptoms of a blocked carotid artery may includetemporary muscle weakness or blindnesson one side of the body.
Surgery is offered to possible candidates only after special evaluation is donewith various X-ray tests to determine the amount of blockage a person has. Thesurgeon then discusses the risks and benefits of surgery. The benefit of CEA isthat the chance of having a stroke in the future is reduced. Strokes can causedeath and permanent disability, such as the inability to talk or move. Peoplewho are candidates for this surgery must then decide whether or not they wantto have the operation.
How is the procedure performed?
A carotid endarterectomy is usually done in the hospital using generalanesthesia. With general anesthesia, the person is put to sleepcompletely with medications. Occasionally, the surgeon will prefer to uselocalanesthesia. This means the area where the incision will be made isinjected with medications to numb it, but the person stays awake. The choice ofanesthesia will be discussed by the surgeon and anesthesiologist before thesurgery. An anesthesiologist is a doctor who specializes in pain controlduring surgery.
To begin the surgery, a cut is made into the neck. The muscle layer beneath theskin is opened, and the carotid artery is separated from the surrounding tissue.The artery must be empty before the surgeon can operate on it. To accomplish this,the artery is clamped with special tools to prevent blood flow. The person isgiven a medication called heparin to thin the blood and prevent blood clots from forming.
Some surgeons prefer to use a shunt to maintain blood flow to the brain. Thisis a small tube that is inserted above and below the area of blockage in theartery before it is clamped. A shunt allows blood to flow around the blockageduring the surgery.
Once blood flow is controlled, the artery is cut open. The blockage is cut outand removed. This leaves a smooth inner layer to the artery. The artery is thensewed shut. Sometimes the artery is patched with a vein or a piece of syntheticmaterial. A special tube, known as a drain, may be placed in the incision todrain any extra blood that collects. The openings in the neck muscles and skin are then sewn shut, andthe wound is bandaged.
Preparation & Expectations
What happens right after the procedure?
After the surgery, the person will be taken to the surgeryrecovery room to be watched closely for a short time. Bloodpressure, pulse, breathing, and awareness will be checked often. The personwill also be checked for any signs of bleeding. The person will need to stay inthe hospital for a day or 2 after the surgery and is allowed to eatnormally and move around once he or she is stable.
Home Care and Complications
What happens later at home?
Most people will have a sore neck where the muscles were cut for a few weeks.This usually can be relieved with heat and pain medication. Most peoplefunction well after returning home. The surgeon provides specific wound careinstructions before sending the person home.
What are the potential complications after the procedure?
Complications from a carotid endarterectomy vary from mild to major. Somepeople have muscle tenderness and mild bleeding. Also, a person may havebruising or bleeding into the neck tissues from the use of the blood-thinningmedication. This is usually not serious and goes away by itself.
Occasionally, there may be nerve damage to 1 of the nerves in the neck orface, which may cause permanent muscle weakness. About 1% of the people whohave a carotid endarterectomy will have a stroke around the time of thesurgery. This risk is higher among people who were having symptoms beforesurgery. Infection and allergicreactions to anesthesia mayoccur. Intracerebral hemorrhage, orbleeding in the brain, is an infrequent but serious complication. Rarely, theperson may have a heart attack or evendie after an endarterectomy.
Article type: xmedgeneral