Carotid endarterectomy (CEA) is a procedure used to remove a blockage in the carotid artery to prevent a stroke from occurring. The carotid arteries are blood vessels located in the neck that supply blood to the brain. There is one carotid artery on each side of the neck. When these vessels become narrowed or blocked or a piece of the clot travels downstream lodging in a smaller vessel in the brain, blood flow to the brain is reduced. 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 they grow older. These are known as atherosclerosis. If the deposits become too big in the carotid arteries, people are at risk for a stroke. Those who have a high degree of blockage in the carotid arteries are at the highest risk for a stroke. These are the people who benefit from a carotid endarterectomy.
People with lower amounts of blockage are only offered a carotid endarterectomy under special circumstances. For example, if a person is having symptoms from a blocked artery even though the blockage is only moderate, he or she may be a candidate for this procedure. Symptoms of a blocked carotid artery may include temporary muscle weakness or blindness on one side of the body.
Surgery is offered to possible candidates only after special evaluation is done with various tests to determine the amount of blockage a person has. The surgeon then discusses the risks and benefits of surgery. The benefit of CEA is that the chance of having a stroke in the future is reduced. Strokes can cause death and permanent disability, such as the inability to talk or move. People who are candidates for this surgery must then decide whether or not they want to have the operation.
How is the procedure performed?
A carotid endarterectomy is usually done in the hospital using general anesthesia. With general anesthesia, the person is put to sleep completely with medications. Occasionally, the surgeon will prefer to use local anesthesia. This means the area where the incision will be made is injected with medications to numb it, but the person stays awake.
The choice of anesthesia will be discussed by the surgeon and anesthetist before the surgery. An anesthetist is a doctor or extensively trained nurse who specializes in pain control during surgery. To begin the surgery, a cut is made into the neck. The muscle layer beneath the skin 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 is given 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. This is a small tube that is inserted above and below the area of blockage in the artery before it is clamped. A shunt allows blood to flow around the blockage during the surgery.
Once blood flow is controlled, the artery is cut open. The blockage is cut out and removed. This leaves a smooth inner layer to the artery. The artery is then sewed shut. Sometimes the artery is patched with a vein or a piece of synthetic material. A special tube, known as a drain, may be placed in the incision to drain any extra blood that collects. The openings in the neck muscles and skin are then sewn shut, and the wound is bandaged.
Schwartz, Principles of Surgery: 7th edition 1999
Meekes, Mary, Care of Patient in Surgery, 1999