Information on Carotid Endarterectomy from the National Heart Lung and Blood Institute
Carotid endarterectomy (ka-ROT-id END-ar-ter-EK-to-me), or CEA, is surgery to remove plaque (plak) from the carotid arteries. These are the two large arteries on each side of your neck. They supply oxygen-rich blood to your brain. The Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows the arteries. This limits or blocks the flow of oxygen-rich blood to your brain, which can lead to a stroke. Read more at the National Heart Lung and Blood Institute, NIH.
Information on Carotid Endarterectomy from the Society for Vascular Surgery
Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow. Read more at VascularWeb.org provided by the Society for Vascular Surgery.
Information on the Carotid Endarterectomy Procedure from Baylor College of Medicine
Physicians perform endarterectomy based on assessments of the blockage caused by plaque in a carotid artery and by considering other factors, such as history of TIA or prior stroke and the status of other vessels supplying blood to the brain in each person. Read more at the Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
Questions and Answers about Carotid endarterectomy
A blockage of a blood vessel is the most frequent cause of stroke and is responsible for about 80 percent of the approximately 700,000 strokes in the United States each year. With nearly 150,000 stroke deaths each year, stroke ranks as the third leading killer in the United States after heart disease and cancer. Stroke is the leading cause of adult disability in the United States with 2 million of the 3 million Americans who have survived a stroke sustaining some permanent disability. The overall cost of stroke to the nation is $40 billion a year. Read more at the National Institute of Neurological Disorders and Stroke, NIH.
Booklet: When you need an operation…
This booklet will explain: • Why you may need to have a carotid endarterectomy • How the blockage is removed from the carotid arteries • What to expect before and after the operation. Read it at the American College of Surgeons.
Fact Sheet: Let's Talk about Carotid Endarterectomy
What is Carotid Endarterectomy, why do I need it, how is it done, what happens after surgery and how can I learn more at the American Stroke Association.
Carotid endarterectomy — an evidence-based review.
Carotid endarterectomy (CE) is established as effective for recently symptomatic (within previous 6 months) patients with 70 to 99% internal carotid artery (ICA) angiographic stenosis (Level A)... Read the complete report of the Therapeutics and Technology Assessment subcommittee of the American Academy of Neurology.
What's new in stroke? The top 10 studies of 2006-2008. Part II.
Six studies from 2006-2008 that have influenced clinical management of stroke and threatened stroke are presented. The ABCD2 score effectively stratifies the short-term risk of stroke following transient ischemic attack into those with a high (12%), moderate (6%), and low (1%) 7-day stroke risk. High-dose atorvastatin reduces recurrent stroke in patients with recent stroke, but probably slightly increases central nervous system hemorrhage (SPARCL). Intravenous tissue plasminogen activator is of overall benefit to selected patients when given 3 to 4.5 hours after ischemic stroke onset (ECASS III). Adjusted-dose warfarin is far superior to aspirin and is relatively safe for very old people with atrial fibrillation (BAFTA). Despite results from 3 recent randomized trials (SAPPHIRE, EVA-3S and SPACE) the optimal role of carotid angioplasty/stenting vs. endarterectomy remains unclear. Enoxaparin once daily is an efficacious alternative to unfractionated heparin twice daily for prevention of venous thromboembolism after acute ischemic stroke (PREVAIL). These recent studies add important pieces to the complex puzzle of optimal stroke prevention and treatment.
Abstract: Synchronous carotid endarterectomy and off-pump coronary bypass: an updated, systematic review of early outcomes.
OBJECTIVES: To update our previous systematic review of outcomes following synchronous carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OFF-CABG). DESIGN: A systematic review of operative risks reported in published studies of synchronous CEA plus OFF-CABG procedures. RESULTS: We identified 12 eligible studies, including data on 324 synchronous CEA plus OFF-CABG procedures. Operative mortality was 1.5% (95% confidence interval (CI): 0.3-2.8), the risk of death or ipsilateral stroke was 1.6% (0.4-2.8%), risk of death or any stroke was 2.2% (95% CI: 0.7-3.7) and the risk of death, stroke or myocardial infarction was 3.6% (95% CI: 1.6-5.5). CONCLUSIONS: Limited published data on 324 patients suggest that early outcomes after synchronous CEA plus OFFCABG are better than those following staged or synchronous CEA plus CABG where the cardiac procedure was performed on-pump. This may, however, be attributed to publication bias, case selection or the fact that the aorta was not manipulated or cannulated, rather than CEA being primarily responsible for the lower stroke risk. Colleagues with unpublished experience of CEA plus OFF-CABG are encouraged to submit their data to further inform the debate.
Abstract: Treatment of carotid artery stenosis: medical therapy, surgery, or stenting?
With the aging of the general population and the availability of noninvasive imaging studies, carotid artery stenosis is a disease commonly seen in general medical practice. Differentiation between symptomatic and asymptomatic disease is critical to the treatment course because the natural history differs markedly between them. Antiplatelet therapy and aggressive treatment of vascular risk factors are the mainstays of medical therapy. Class I evidence shows that carotid endarterectomy (CEA) is effective in preventing ipsilateral ischemic events in patients with symptomatic moderate- and high-grade stenosis. The procedure is also effective in selected patients with asymptomatic stenosis, but the benefit is marginal. In the past decade, carotid angioplasty and stenting has been proposed as a valid alternative to CEA. Currently, it is unclear whether carotid angioplasty and stenting is as safe as CEA in patients with carotid artery stenosis who need invasive treatment. Large clinical trials are under way to answer this question.
Abstract: Arterial pressure management and carotid endarterectomy
Acute perioperative changes in arterial pressure occur frequently, particularly in patients with cardiovascular disease or those receiving vasoactive medications, or in relation to certain cardiovascular surgical procedures. Both hypo- and hypertension are common in patients undergoing carotid surgery because of unique patho-physiological and surgical factors. Poor arterial pressure control is associated with increased morbidity and mortality after carotid endarterectomy, but good control of arterial pressure is often difficult to achieve in practice. New guidelines have emphasized the benefits of performing carotid surgery urgently in patients with acute neurological symptoms. This strategy may make perioperative arterial pressure control more challenging. However, few specific data are available to guide individual drug therapy. The incidence, implications, and aetiology of haemodynamic instability associated with carotid surgery are reviewed, and some recommendations made for its management. Close monitoring and titration of therapy are probably the most important considerations rather than specific choice of agents.
Abstract: Bilateral carotid endarterectomy as treatment of vascular pulsatile tinnitus.
Atherosclerotic carotid artery disease (ACAD) is a rare but recognized cause of pulsatile tinnitus. Existing literature of reported cure for pulsatile tinnitus is reviewed. We found: (1) a male preponderance exists; (2) ipsilateral carotid endarterectomy (CEA) for tinnitus is 92% (12 of 13) effective; (3) proximal lesions lend themselves to CEA whereas distal lesions have been treated by stenting; (4) overall 68% (15 of 22) are cured by intervention; and (5) 89% (17 of 19) can expect immediate relief. We now present a case of bilateral pulsatile tinnitus relieved by bilateral carotid endarterectomy.
Abstract: Metaanalysis of procedural stroke and death among octogenarians: carotid stenting versus carotid endarterectomy
No abstract available
Abstract: Carotid artery stenting--controversy of indication and clinical results
Carotid endarterectomy (CEA) is a well-established surgical treatment for carotid artery stenosis. Carotid artery stenting (CAS) is a preferred treatment strategy in high-risk patients requiring surgery. Lacunar stroke has been the most prevalent stroke type among the Japanese. Recently carotid artery atherosclerotic thrombosis cases have been more frequently in Japan. Poor of CAS results are obtained with thrombo-embolic complications. Distal protection devices have been developed to avoid such complications. Even though approved indication for CAS is high risk associated with surgery, it is being increasingly employed since SAPPHIRE trial of 2004. Some trial proved negative results against CAS. Patient selection for CAS is still controversial. Indications and results of CAS are discussed.
Abstract: Patches for carotid artery endarterectomy: current materials and prospects.
Patch angioplasty is commonly performed after carotid endarterectomy. Randomized prospective trials and meta-analyses have documented improved rates of perioperative and long-term stroke prevention as well as reduced rates of restenosis for patches compared with primary closure of the arteriotomy. Although use of vein patches is considered to be the gold standard for patch closure, newer generations of synthetic and biologic materials rival outcomes associated with vein patches. Future bioengineered patches are likely to optimize patch performance, both by achieving minimal stroke risk and long-term rates of restenosis as well as by minimizing the risk of unusual complications of prosthetic patches such as infection and pseudoaneurysm formation. In addition, lessons from bioengineered patches will likely enable construction of bioengineered and tissue-engineered bypass grafts.
Abstract: Carotid stenting: an alternative to surgery?
A stenosis of the internal carotid artery may cause 10-20% of all ischemic strokes. In symptomatic patients, carotid revascularization is indicated in the presence of a stenosis 50%. in asymptomatic patients, the indication for revascularization based on randomized trials is given at > or = 60% stenosis, as long as the estimated perioperative death or stroke risk is < 3%. In clinical practice however, asymptomatic stenoses are usually treated only if luminal narrowing exceeds 70-80%. The choice of the revascularization strategy (endarterectomy versus stenting) should be based on the surgical risk profile of the patient and on the locally available expertise. Carotid artery stenting is particularly beneficial in patients at high risk for surgery.
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Carotid Endarterectomy Video (Contains graphic surgical images)
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