What Is a Carotid Endarterectomy?

A carotid endarterectomy (CEA) is a procedure that is performed to prevent strokes in patients who have carotid artery disease. This disease occurs when plaque builds up and hardens in the walls of the two large arteries on each side of the neck, keeping oxygen-rich blood from reaching the brain.

In addition to obstructing blood flow due to buildup, a stroke can also occur when a piece of plaque breaks loose from the artery wall and eventually becomes lodged in one of the smaller arteries in the brain. Plaque may also break away and leave an injured portion of the lining of the artery to fill with platelets and form a clot, which can result in blockage.

Risk factors for developing carotid artery disease include:

  • Being obese
  • Excessive alcohol consumption
  • Family history of atherosclerosis
  • High blood pressure
  • High cholesterol and certain fats in diet
  • High levels of sugar in the blood due to diabetes or insulin resistance
  • Sedentary lifestyle
  • Smoking

Who Benefits From a Carotid Endarterectomy?

A CEA can potentially lower the risk of:

  • Stroke in patients with narrowed arteries (carotid stenosis) or blocked arteries (50 to 79 percent blockage)
  • Stroke in patients with significant blockage (over 80 percent) in the arteries but no stroke symptoms
  • Stroke in patients experiencing symptoms
  • Transient ischemic attack (TIA)—a “mini-stroke” that causes temporary stroke-like symptoms for up to 24 hours—in patients experiencing symptoms

What Can Be Expected During a Carotid Endarterectomy?

During a CEA, the surgeon makes an incision in the neck and removes the plaque buildup in the artery walls. This allows full blood flow to be restored. There are two approaches to this procedure:

  1. The blockage is cleared out by clamping off and cutting into the artery to remove the plaque buildup.
  2. The section of the artery with blockage is clamped, turned inside out, cleaned of plaque and then placed back in its original position.

What Is a Carotid Angioplasty and Stent? When Should It Be Considered Instead of a Carotid Endarterectomy?

With a carotid angioplasty and stent (CAS), a balloon is threaded through a blood vessel in the neck to the artery, then inflated to push the deposit of plaque away. Once the balloon is in place, a small metal or mesh tube known as a stent is placed within the artery to help maintain proper blood flow.

CAS and CEA are both acceptable methods of treating carotid artery disease, but CAS may be an ideal alternative for patients with a high risk of surgical complication. Patients should speak to a specialist to see which treatment is right for them.