Carotisendarterectomie

Carotisendarterectomie, commonly referred to as carotid endarterectomy (CEA), is a vascular surgical procedure aimed at removing atherosclerotic plaque from the carotid artery. The goal is to restore normal blood flow to the brain and reduce the risk of ischemic stroke in patients with carotid artery stenosis.

Indications typically include symptomatic significant carotid stenosis, such as a recent transient ischemic attack or stroke attributed to carotid disease, and, in carefully selected patients, asymptomatic high-grade stenosis where the anticipated benefit justifies the operative risk. Patient selection depends on imaging findings, overall medical risk, and the likelihood of stroke reduction with surgery.

Diagnosis and preoperative evaluation rely on imaging studies such as duplex ultrasonography, CT angiography, or MR angiography to measure stenosis and assess plaque characteristics. Additional assessments consider cardiovascular risk, cerebral perfusion, and anesthesia risk. The procedure is planned within a multidisciplinary framework, often with medical optimization beforehand.

Technique and intraoperative considerations: surgery is commonly performed under general anesthesia. An incision is made along the neck to expose the carotid bifurcation. After systemic anticoagulation, a shunt may be used in selected cases to maintain cerebral perfusion. An arteriotomy is performed, the plaque is removed, and the vessel is reconstructed, typically with patch angioplasty to reduce restenosis. The wound is closed with attention to hemostasis and nerve protection.

Postoperative care focuses on blood pressure control, antiplatelet therapy, and monitoring for complications such as stroke, cranial nerve injury, hematoma, or infection. In experienced centers, perioperative stroke or death rates are low, and restenosis has declined with the use of patch techniques. Carotid stenting is an alternative for patients at high surgical risk.