Alternate Names : CEA
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, 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. This is 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
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 X-ray 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
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 anesthesiologist before the
surgery. An anesthesiologist is a doctor who specializes in pain control
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.