Endarterectomy

Endarterectomy is a surgical procedure to remove atheromatous plaque from the inner lining of an artery, most often the carotid artery in the neck, to restore blood flow and reduce the risk of stroke. The operation most commonly performed for carotid artery stenosis is carotid endarterectomy (CEA). Less commonly, endarterectomy can be done on other arteries, such as the femoral or renal arteries.

Indications for endarterectomy include symptomatic carotid stenosis, where a patient has had a transient ischemic attack or nondisabling stroke attributed to the narrowing and has a substantial degree of narrowing. It is also considered in selected asymptomatic patients with high-grade stenosis after risk assessment and discussion of potential benefits and risks.

Procedure overview: The operation is usually performed through an incision in the neck to expose the carotid artery. After temporarily clamping the vessel, an arteriotomy is made and the plaque is carefully removed from the artery wall. The artery is then repaired, often with a patch to widen the lumen and reduce the chance of restenosis. A shunt may be used in some cases to maintain cerebral perfusion during the repair. The surgery can be done under general or regional anesthesia, and postoperative care includes blood pressure management and antiplatelet therapy.

Outcomes and risks: When used in appropriately selected patients, endarterectomy reduces the risk of disabling stroke compared with medical therapy alone. Perioperative risks include stroke or transient ischemic attack, myocardial infarction, cranial nerve injury, wound complications, and restenosis. Patch angioplasty and careful patient selection help mitigate some risks.

Alternatives and considerations: Carotid artery stenting is a less invasive option that may be preferred in certain patients, depending on anatomy and risk profile. Medical therapy alone remains an option for many individuals, particularly those at higher surgical risk.