For more information, visit http://www.nhlbi.nih.gov/health/health-topics/topics/carend/

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).

Other Names for Carotid Endarterectomy

Carotid endarterectomy also is called carotid artery surgery.

Who Needs Carotid Endarterectomy?

Your doctor may recommend carotid endarterectomy (CEA) if you have carotid artery disease. CEA can help prevent strokes in people who have this disease.

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), also called a "mini-stroke." During a TIA, 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).
Severely blocked carotid arteries (even if you don't have stroke symptoms).

Other Treatments for Carotid Artery Disease

Anticlotting medicines, such as aspirin and clopidogrel, also are used to treat people who have carotid artery disease. These medicines help reduce blood clotting and lower the risk of stroke.

A procedure called carotid angioplasty may be used instead of CEA to treat blocked carotid arteries. 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 reduces the risk that the artery will become blocked again.

What To Expect Before Carotid Endarterectomy

Your doctor will tell you how to prepare for carotid endarterectomy (CEA). Before CEA, you may have one or more tests to examine your carotid arteries. These tests can show whether your arteries are narrowed and how much they're narrowed.

Carotid Ultrasound

Carotid ultrasound is a painless and harmless test that uses sound waves to create pictures of the insides of your carotid arteries.

A carotid ultrasound test may include a Doppler ultrasound study. Doppler ultrasound shows the speed and direction of blood flow through your blood vessels.

Carotid Angiography

Carotid angiography is a special type of x ray. For this test, a small tube called a catheter is put into an artery, usually in the groin (upper thigh). The tube is then moved into one of your carotid arteries.

A substance called contrast dye is injected into the carotid artery. This dye outlines the artery and any blockages on the x-ray pictures.

Magnetic Resonance Angiography

Magnetic resonance angiography (MRA) is a test that creates pictures of your carotid arteries using a large magnet and radio waves. Your doctor can see these pictures on a computer screen.

Contrast dye may be used during MRA. The dye makes your arteries show up better on the pictures. (The contrast dye used for MRAs is different from the contrast dye used for x-ray tests.)

Computed Tomography Angiography

Computed tomography (to-MOG-rah-fee) angiography, or CT angiography, is a test that uses x rays to take pictures of your body from many angles. A computer combines the pictures into two- and three-dimensional images.

Contrast dye may be used during CT angiography. The dye makes your arteries show up better on the pictures.

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 (AN-es-THE-ze-ah) during the surgery so you don't feel pain. The term "anesthesia" refers to a loss of feeling and awareness. 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 from flowing 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 around the blockage.

Finally, your surgeon will close the artery with stitches and stop any bleeding. He or she will then close the incision in your neck.

If you have small arteries or have already had a CEA, your surgeon might place a patch over the cut in the artery before closing the incision in your neck. The patch may reduce the risk of stroke for some patients.

Carotid Endarterectomy

The illustration shows the process of carotid endarterectomy. Figure A shows a carotid artery with plaque buildup. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows how the carotid artery is cut and how the plaque is removed. Figure C shows the artery stitched up and normal blood flow restored. The inset image shows a cross-section of the artery with plaque removed and normal blood flow restored.

Some surgeons use another technique called eversion carotid endarterectomy. For this surgery, one of the branches of the carotid artery is cut and turned inside out. The plaque is then cleaned out and the artery is reattached.

What To Expect After Carotid Endarterectomy

After carotid endarterectomy (CEA), you may stay in the hospital for 1 to 2 days. This allows you to safely recover from the procedure.

If your surgery takes place early in the day and you're doing well, you may be able to go home the same day.

Recovery

For a few days after the surgery, your neck may hurt. You also may find it hard to swallow. Your doctor may advise you to eat soft foods that are easy to swallow until your neck isn't as sore. Your doctor may prescribe medicine to help control any pain or discomfort.

Talk with your doctor about when it's safe for you to go back to your normal activities after having CEA.

Ongoing Care

After CEA, ongoing care and treatment are important. Discuss your treatment needs with your doctor. Ask him or her when you should schedule followup visits.

Talk with your doctor about when to seek emergency care. Problems that require urgent care may include severe headaches and swelling in the neck. Signs or symptoms that suggest a stroke or transient ischemic attack (TIA, or "mini-stroke") also require urgent care. These signs and symptoms may include:

Numbness or weakness of the face, arms, or legs, especially on one side of the body
Confusion and trouble speaking or understanding speech
Trouble seeing in one or both eyes
Dizziness, trouble walking, loss of balance or coordination, and unexplained falls
Severe headache with no clear cause

Let your doctor know if you have questions about any of your medicines or how to take them. After CEA, your doctor may prescribe anticlotting medicines, such as low-dose aspirin and clopidogrel. These medicines help prevent blood clots from forming or getting larger.

As part of your long-term treatment, you can take steps to keep your carotid arteries healthy. One important step is to not smoke. Smoking increases the risk of carotid artery disease and stroke.

If you smoke, ask your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart." Although these resources focus on heart health, they include general information about how to quit smoking.

Follow your treatment plan for high blood pressure and high blood cholesterol. This can help prevent plaque buildup and blood clots in your carotid arteries.

Some people need a second CEA due to repeat plaque buildup. Following your treatment plan can help lower your chance of needing a second CEA; it also can reduce your risk of stroke.

What Are the Risks of Carotid Endarterectomy?

Carotid endarterectomy (CEA) is fairly safe when done by surgeons who have experience with it. However, serious complications, such as stroke and death, can occur.

CEA also can cause less serious complications. For example, you may have a bad reaction to the anesthesia, bleeding, or infection. Short-term nerve injury may cause numbness in your face or tongue.

Certain factors may raise your risk of having CEA complications. For example, women are at higher risk of complications than men. Other risk factors include having diabetes or other serious medical conditions. People who are older
than 75 and have other risk factors also are at higher risk.

Talk with your doctor about the risks of CEA. He or she can help you decide whether the surgery may benefit you.

Links to Other Information About Carotid Endarterectomy

NHLBI Resources

Carotid Artery Disease (Health Topics)
Stroke (Health Topics)

Non-NHLBI Resources

Carotid Artery Surgery (MedlinePlus)
Questions and Answers About Carotid Endarterectomy (National Institute of Neurological Disorders and Stroke)

Clinical Trials

Clinical Trials (Health Topics)
Current Research (ClinicalTrials.gov)
NHLBI Clinical Trials
NIH Clinical Research Trials and You (National Institutes of Health)
ResearchMatch (funded by the National Institutes of Health)