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carotid endarterectomy

overview

A carotid endarterectomy (CEA) is a surgical procedure that removes plaque from your carotid arteries, which are located on each side of your neck and supply oxygenated blood to your brain. When plaque builds up inside your carotid arteries, it causes them to harden and narrow. This limits blood flow to your brain, which increases your risk of a stroke or a transient ischemic attack (TIA), also known as a mini-stroke. A CEA restores normal blood flow to your brain, reducing your stroke risk.

evaluation

Before your CEA, your doctor may request one or more of the following tests to determine the extent of your carotid artery disease:

  • Carotid angiography – uses a catheter, contrast dye and X-rays to show where the carotid artery has narrowed
  • Carotid ultrasound – uses sound waves to create an image of the inside of your carotid arteries
  • CT scan (or CTA) – uses X-rays to take pictures of the carotid arteries from many angles and produces a multi-dimensional image
  • Doppler ultrasound – shows the speed and direction of blood flow through the carotid arteries
  • Magnetic resonance imaging (MRI or MRA) – uses a large magnet and radio waves to create pictures of the carotid arteries. Contrast dye may be used to improve visibility.

Like most surgeries, this one has potential risks. Specific CEA risks include a possible reaction to anesthesia, bleeding, infection or nerve injury that could cause numbness to your face or tongue. Although rare, serious complications such as a stroke or death could occur.

Factors that increase CEA complications include being female, older than 75, or having diabetes or another serious medical condition.

what to expect

Your surgeon will make an incision in your neck and remove the plaque that has built up in the carotid artery. The procedure typically lasts 2 hours.

Most people have two options regarding anesthesia, which you should discuss with your surgeon. General anesthesia temporarily puts you to sleep, while local anesthesia only numbs only the surgical area, allowing the surgeon to talk to you during the procedure.

With either type of anesthesia, you will be fully monitored with a blood pressure cuff, heart monitor and pulse oximeter (to measure oxygen levels in your blood). You’ll also receive oxygen and peripheral IVs.

recovery

After surgery, you may have a sore neck for a few days and some difficulty swallowing. You can expect to recover in the hospital for a day or two after the procedure. Your doctor will prescribe pain medication to help make your recovery more comfortable. To reduce the risk of developing a blood clot, your doctor may prescribe aspirin and/or Plavix. Be sure to seek emergency care if you experience a severe headache, signs of a stroke or TIA, or swelling in the neck.

Your doctor will advise you on when you may resume your normal activities, including driving.

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