Carotid endarterectomy

A carotid endarterectomy removes blockages in the carotid arteries, which are major blood vessels in the neck that supply blood to the brain and head. These arteries can narrow due to fatty deposits, also known as plaque. Plaque sticks to your artery walls and can restrict or stop blood flow, increasing your risk of stroke and transient ischemic attacks (TIAs), also known as mini strokes. A carotid endarterectomy (CEA) opens and cleans your carotid arteries to improve blood flow.

CEA procedures are performed by vascular surgeons who work alongside advanced practice providers, technicians, and anesthesiologists who specialize in artery treatment. At Penn Medicine, we’ve provided expert care to people with carotid artery disease for decades. As part of our Vascular Surgery and Endovascular Therapy Program, we offer specialized endarterectomy techniques and expertise that may not be found in other hospital settings, so you have easy access to a wide range of care options.

Vascular surgeons may recommend one of two open surgery approaches for carotid artery treatment. They’ll evaluate your specific carotid artery damage, assess your overall health history, and decide on the best treatment plan for you.

• Traditional carotid endarterectomy: Using this method, an incision is made along your carotid artery. This makes it easier for your surgeon to use a shunt, a tube to keep blood flowing to your brain while surgery is performed. The surgeon closes the artery with a patch from another blood vessel in your body or with a synthetic material.
• Eversion carotid endarterectomy: With this approach, your surgeon makes an incision that crosses the carotid artery. They can close this incision without a patch, which can reduce the chance of carotid artery disease re-occurring in the future. Our surgeons are highly skilled at performing this method, which requires technical expertise that may not be widely available elsewhere.

Some people aren’t good candidates for open surgery because it may be too great a risk for their overall health. In these cases, we perform minimally invasive procedures, including carotid angioplasty and stenting or transcarotid artery revascularization (TCAR). These approaches use a catheter (a long, flexible tube with a camera and tools at the end) inserted through a small puncture in your groin. After threading the catheter to the blockage, the surgeon cleans your carotid artery. Then the surgeon places a stent (a small wire mesh tube) to hold the artery open and keep blood flowing.

People with severe carotid artery disease are potential candidates for a carotid endarterectomy. Common causes of carotid artery disease include atherosclerosis (hardening of the arteries) and arterial stenosis, both of which cause plaque buildup in the carotid arteries.

Early-stage plaque buildup may not cause symptoms. Though if a carotid artery is significantly narrowed, you may experience symptoms that require immediate attention such as:

• Blurred vision or vision loss
• Confusion
• Memory loss
• Numbness or weakness in part of your body or one side of your body
• Problems with thinking, reasoning, memory, and speech

Some risk factors may make you more likely to develop carotid artery disease, although having these risks factors does not mean you’ll get the disease. They include:

• Diabetes
• A family history of stroke
• High blood pressure, high cholesterol, or high triglycerides
• Older age, especially if you are male
• Smoking or using alcohol or recreational drugs
• Trauma to your neck

A carotid endarterectomy is a commonly performed procedure that usually lasts up to two hours. While specific surgical processes may vary, CEA procedures generally follow these steps:

• An intravenous (IV) line will be used to deliver local anesthesia with sedation or general anesthesia to help put you to sleep or relax during the procedure. A dedicated vascular anesthesiologist will be on hand to monitor you throughout surgery.
• Your surgeon will make an incision in your neck to access the artery. Your doctor may place a temporary shunt, a tube that diverts blood flow around the blocked artery to send blood to your brain, while working on the carotid artery.
• Your surgeon will remove the plaque from the artery to clean it out. They may also insert a stent (a tiny wire mesh tube) to hold the artery open.
• Your artery will be closed with stitches or special patches, and then the surgeon will close the incision.
• You may have a drain, a small tube to let extra blood and fluids drain from your neck. Your health care team will remove the drain, usually the next day.
• Most people stay in the hospital for a day or two after a carotid endarterectomy. You’ll receive instructions for wound care and pain management when you are ready to go home.

After you go home, you can usually resume regular daily activities within a few weeks and return to more strenuous activities in about a month. Many people have similar experiences while they recover from plaque removal surgery:

• It’s common to have pain around the surgical site. Your doctor will recommend over-the-counter drugs or pain medications to keep you comfortable.
• You’ll likely have a sore throat and stiff neck for a week or two. These symptoms will resolve over time.
• You may need to start taking new prescription medications or follow a special diet to reduce the risk of plaque building up again in your carotid artery.
• You’ll have follow-up appointments to be sure you are recovering well. Be sure to talk with your doctor about any lingering symptoms and steps you can take to stay healthy.

Like all surgeries, there are some risks with carotid endarterectomy treatment. Your doctor will discuss these risks with you prior to surgery and address any questions or concerns you have.

• Stroke, mini stroke, or heart attack
• Bleeding in the brain
• Swelling or bleeding near the incision
• High blood pressure
• Irregular heartbeat
• Infection
• Nerve damage to some eye, nose, tongue, or ear functions

Carotid endarterectomy treatment requires expertise and experience from a team of vascular specialists. Penn Medicine is a national leader in these specialized techniques. Our expert doctors and providers will work with you to pinpoint an accurate diagnosis and deliver the right treatment safely and effectively. We take time to discuss your options and ensure that you are comfortable with the treatment plan.

When you come to Penn Medicine for carotid artery treatment, you can expect:

• A high-volume center: As a national leader in the treatment of carotid artery stenosis and stroke prevention, our vascular surgeons have performed more carotid interventions than any other medical center in the southeastern Pennsylvania and New Jersey regions. We treat more than 200 people each year, a large number, and have an exceptionally high success rate.
• Wide-ranging options: When our physicians evaluate your case, you’ll have access to every available option to treat your carotid artery disease. In addition to open CEA surgery, you may be a candidate for minimally invasive carotid angioplasty and stenting and transcarotid artery revascularization (TCAR) procedures, which can lead to faster recovery times and fewer complications.
• Recognized expertise: Doctors refer patients with the most challenging carotid artery conditions to us for treatment. You can count on us to help find the most appropriate treatment for you and reduce the likelihood of stroke, so you stay healthy.