Carotid endarterectomy (CEA) is a vascular surgery aimed at reducing stoke risk by removing plaque from the carotid arteries. This can be a lifesaving surgery for patients living with carotid artery disease. While the most common complication is stroke, the risk is relatively low and can be managed with careful surgical techniques and postoperative care.
Before we go into more depth on carotid endarterectomy, let’s talk about carotid artery disease.
What is carotid artery disease?
Carotid artery disease happens when the carotid arteries narrow or become blocked. These arteries, located on each side of the neck, are responsible for carrying blood to the brain and head.
When a carotid artery becomes blocked, blood flow to the brain, face and head is limited or even fully cut off.
Carotid artery disease is often the result of atherosclerosis, which means fatty plaque has built up along the walls of blood vessels. This plaque can block blood from traveling through the artery.
The carotid artery can sometimes become blocked by a blood clot, which can then travel through the bloodstream to the brain. Regardless of what causes the blockage, carotid artery disease can lead to serious and life-threatening health issues, including stroke.
What is carotid endarterectomy?
Carotid endarterectomy involves making an incision in the neck to reach the carotid artery and removing the plaque causing the narrowing. This helps restore normal blood flow to the brainand reduces the risk of stroke. However, like any surgery, CEA carries risks.
Most common serious complication: stroke
The most common complication after a carotid endarterectomy is a stroke. Yes, even though theprocedure is meant to prevent strokes, there is a small risk of stroke during or after the procedure. This happens in about 1-2% of patients who haven’t had a stroke before. The risk is slightly higher in patients who have already experienced a stroke or transient ischemic attack(TIA), sometimes called a “mini-stroke.”
Why does stroke occur with carotid endarterectomy?
Several factors can contribute to the risk of a stroke after CEA:
- Dislodged Plaque: During the surgery, small pieces of plaque can break off and travel to the brain, causing a blockage.
- Blood Clots: Blood clots can form at the site of the surgery and travel to the brain.
- Hypotension: Low blood pressure during or after surgery can reduce blood flow to the brain.
Addressing your safety concerns
If you are worried about the risks of carotid endarterectomy, here are some common concerns and how they are addressed:
- Risk of stroke: This risk is low. Vascular surgeons take several precautions to minimize this risk, such as using anticoagulants to prevent blood clots and carefully monitoring blood pressure during and after the procedure.
- Recovery time: Recovery from CEA typically involves a short hospital stay, usually 1-2 days. Most patients can return to normal activities within a few weeks.
- Pain and discomfort: Pain is usually minimal and can be managed with medication. Patients may experience some discomfort at the incision site, but this typically resolves within a few days.
Alternative minimally invasive procedures
For patients concerned about the risks of carotid endarterectomy, there are alternative minimally invasive procedures available. Talk to your vascular surgeon about which procedure option will provide the best outcome for your unique needs.
- Carotid artery stenting (CAS): This procedure involves placing a stent in the carotid artery to keep it open. It is performed using a catheter inserted through a small incision in the groin. CAS is less invasive than CEA and may be a better option for patients who are at high risk for surgery.
- Transcarotid artery revascularization (TCAR): TCAR is a newer procedure that combines elements of both CEA and CAS. It involves making a small incision in the neck and using a special device to place a stent in the carotid artery. TCAR is designed to reduce the risk of stroke during the procedure by temporarily reversing blood flow in the carotid artery.
Connect with our program
Carotid endarterectomy is a valuable vascular procedure for preventing strokes in patients with carotid artery disease. While the most common complication is stroke, the risk is relatively low and can be managed with careful surgical techniques and postoperative care. For patients seeking less invasive options, carotid artery stenting and transcarotid artery revascularization areeffective alternatives.
Our expert vascular surgeons, advanced practitioners and clinical staff can guide you to the best treatment for your needs. To get started, click the button below to select a surgeon, or call NGPG Vascular Center at 770-219-4000.
William Zickler, MD, is a vascular surgeon with NGPG Vascular Center.