Sunday, December 18, 2011

Carotid Endarterectomy

Carotid endarterectomy, or CEA, is surgery to remove plaque 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 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.
CEA and carotid angioplasty 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
Excerpted from text by the National Heart, Lung, and Blood Institute (NHLBI,, part of the National Institutes of Health, February 2009.
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.
Anti platelet 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.
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.
When Carotid Endarterectomy Is Needed
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” • Severely blocked carotid arteries (even if you don’t have stroke symptoms)
What to Expect before Carotid Endarterectomy
Your doctor will talk to you about how to prepare for carotid en darterectomy (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.
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 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.
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.


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