Endarterectomia

Endarterectomia, or endarterectomy, is a surgical procedure to remove atherosclerotic plaque from an artery in order to restore normal blood flow. It is most commonly performed in the carotid arteries of the neck to reduce the risk of stroke in patients with carotid stenosis.

Indications for carotid endarterectomy include symptomatic carotid stenosis, typically in patients who have had transient ischemic attacks or non-disabling strokes attributed to the affected carotid territory, and with moderate to severe narrowing. It is also considered in certain asymptomatic patients with high-grade stenosis and favorable overall surgical risk, depending on guideline recommendations and individual risk factors. Preoperative evaluation uses duplex ultrasonography and cross-sectional imaging such as CT or MR angiography, along with assessment of cardiovascular risk.

The operation is usually performed under general anesthesia, though regional anesthesia with awake monitoring may be used in some centers. After exposing the carotid bifurcation, the artery is opened and the atherosclerotic plaque is removed from the lumen. A patch angioplasty may be used to widen the artery and reduce the chance of restenosis. A temporary shunt may be employed to maintain cerebral perfusion during the procedure. The artery is then closed and the incision repaired. An eversion endarterectomy is an alternative technique in some cases.

Postoperative care includes careful blood pressure control and neurologic monitoring. Recovery is typically completed within a few days, and the procedure lowers the long-term risk of stroke in appropriately selected patients. Complications can include perioperative stroke or myocardial infarction, cranial nerve injury, hematoma, wound infection, and restenosis. Carotid artery stenting is a less invasive alternative in selected patients, especially those at higher surgical risk.