Surgery & Perioperative/Vascular

Carotid endarterectomy

also: CEA · carotid surgery

Overview

Removal of carotid plaque to prevent stroke in symptomatic significant carotid stenosis.

Mechanism

Surgical removal of the atheromatous plaque from the carotid artery → reduces the source of emboli and future stroke risk. Done early after the index event for maximum benefit.

Indications

Symptomatic carotid stenosis ~50–99% (after TIA/non-disabling stroke), ideally within 2 weeks

The agents

Endarterectomyopen

Standard.

Carotid stentingendovascular

Selected patients.

Adverse effects

Peri-operative strokeserious

Cranial nerve injury (e.g. hypoglossal)common

MI, neck haematomacommon

Cautions & contraindications

Asymptomatic / <50% stenosis / total occlusionall

Benefit limited.

Choosing it

Recent TIA or non-disabling ischaemic stroke, with ipsilateral carotid stenosis 50–99% on imaging.

Source: NICE — Stroke/TIA (NG128)