Carotid endarterectomy (CEA) is a type of surgery used to treat carotid stenosis. Carotid stenosis is the narrowing of one or both of the arteries leading to the head and neck. During a CEA microsurgical procedure, a UPMC neurosurgeon removes plaque blocking the carotid artery in the neck.
Treating your carotid stenosis with a carotid endarterectomy can reduce your risk of:
UPMC surgeons use carotid endarterectomy to open narrowed carotid arteries. They also remove blockages with this procedure.
Carotid endarterectomy helps restore normal blood flow to your brain. When blood flows as it should, you are less likely to:
The carotid artery on each side of your neck carries blood to your brain and face. Over time, your carotid arteries may become blocked or narrowed by a fatty substance called plaque.
When plaque builds up in these arteries, you have carotid artery disease. Blockage or narrowing of your carotid arteries in carotid artery disease increases your risk of:
You may have carotid artery disease and not know it. Some people do not have symptoms even if the carotid artery narrowing is severe.
Your doctor may hear a sound called a bruit (pronounced “brewy") when they listen to your neck with a stethoscope. As the disease worsens, you may experience stroke-like symptoms.
Your doctor will discuss whether carotid endarterectomy can help protect you from a stroke. They consider:
Your doctor may recommend carotid endarterectomy if narrowing occurs in more than 70% of your carotid artery. They may also consider the procedure if your artery is 50% blocked and you've had stroke-like symptoms.
In some cases, doctors can use minimally invasive techniques instead of carotid endarterectomy. These approaches use tiny instruments inserted through small incisions. This avoids opening the neck or head.
Minimally invasive techniques to treat carotid stenosis include:
Carotid endarterectomy isn't right for everyone. Your doctor may not recommend this procedure if you have:
Complications of carotid endarterectomy may occur in some people. Risks include:
Your doctor will discuss whether carotid endarterectomy is right for you. Here's what to expect from this procedure.
First, your doctor explains what will happen during the carotid endarterectomy. Tell your doctor about any medications you take (including over-the-counter medicines and supplements). They may ask you to stop taking certain medications before your surgery.
On the day of your scheduled surgery, you'll arrive at the hospital and change into a hospital gown. You receive medicine so you won't feel any pain during the procedure. You may have:
Carotid endarterectomy usually takes about two hours. Specialists check your heart rate and blood pressure throughout the procedure.
During the carotid endarterectomy, the surgeon makes a small incision in your neck. They then pull back other tissues and find the carotid artery.
Your brain is monitored to make sure there is enough blood flow through the procedure. The carotid artery is clamped and opened to remove the plaque. If the brain is not receiving enough blood flow during the clamping, a flexible tube (catheter) is inserted in your neck to help blood flow around the blocked or narrow area. The catheter makes sure blood keeps flowing to your brain during surgery. The team monitors the brain activity to make sure blood flow stays consistent.
Once the artery is clear, your surgeon uses stitches to close the artery and the skin in your neck.
You'll stay in a recovery area while your anesthesia wears off. Your care team continues to check your heart rate and blood pressure during this time. You'll then move to a hospital room so doctors can watch you and ensure blood flows to your brain.
After carotid endarterectomy, fluid sometimes collects near the incision. Your doctor may put a drain in your neck to empty this fluid. The drain typically stays in place for one day.
If you're healing well, you should be able to go home in a day or two. Your doctor will discuss what to expect as you recover at home.
Call your doctor right away if you have new or worsening symptoms after carotid endarterectomy.
Tell your doctor if you have:
Carotid endarterectomy can clear plaque from your carotid artery. But plaque can — and often does — return after the procedure.
To reduce the development of plaques, your doctor will suggest certain lifestyle changes. They may include:
UPMC specialists offer an expert diagnosis of carotid artery disease and treatment with carotid endarterectomy.
Medically reviewed by Paul Andrew Gardner, MD and Robert Max Friedlander, MD on 9-10-24.
