What Is Carotid Endarterectomy?

Carotid endarterectomy (ka-ROT-id END-ar-ter-EK-to-me), or CEA, is a type of surgery that is used to prevent strokes in people who have carotid artery disease.

Carotid artery disease occurs if plaque (plak) builds up in the two large arteries on each side of your neck (the carotid arteries). The carotid arteries supply your brain with oxygen-rich blood.

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows the carotid arteries. This limits or blocks the flow of oxygen-rich blood to your brain, which can lead to a stroke.

Carotid Arteries

You have two common carotid arteries—one on each side of your neck—that divide into internal and external carotid arteries. Figure A shows the location of the right carotid artery in the head and neck. Figure B is a cross-section of a normal carotid artery that has normal blood flow. Figure C is a cross-section of a carotid artery that has plaque buildup and reduced blood flow.

A stroke also can occur if the plaque in a carotid artery cracks or ruptures (bursts). Blood cell fragments called platelets (PLATE-lets) 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.

A piece of plaque or a blood clot also can break away from the wall of the carotid artery. The plaque or clot can travel through the bloodstream and get stuck in one of the brain's smaller arteries. This can block blood flow in the artery and cause a stroke.

Overview

During CEA, a surgeon makes an incision (cut) in the neck and removes plaque buildup from a carotid artery. This helps restore normal blood flow through the artery.

CEA can lower the risk of stroke in people who have narrowed or blocked carotid arteries and stroke or transient ischemic attack (TIA) symptoms. During a TIA, or "mini-stroke," you may have some or all of the symptoms of a stroke. However, the symptoms usually last less than 1–2 hours (although they may last up to 
24 hours).

CEA also can lower the risk of stroke in people who have severely blocked carotid arteries but no stroke symptoms.

Carotid angioplasty (AN-jee-oh-plas-tee) 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 carotid 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 (tube) in the artery. The stent lowers the risk of the artery becoming blocked again.

People who have carotid artery disease also may be given anticlotting medicines. These medicines help reduce blood clotting and lower the risk of stroke.

Outlook

CEA can greatly reduce the risk of stroke in people who have carotid artery disease. The surgery is fairly safe when done by surgeons who have experience with it. However, serious complications, such as stroke and death, can occur. If you have carotid artery disease, talk with your doctor about whether CEA is an option for you.

If you've already had 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 make lifestyle changes (such as quitting smoking).

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