Stroke is the third commonest cause of death after coronary artery disease and malignancy. 20-30% of all "non-bleed" strokes are due to carotid vessel disease.

Carotid Endarterectomy (CEA)

CEA has been the standard surgical treatment for symptomatic, significant carotid disease since its introduction in 1954. CEA entails exposure of the carotid bifurcation and internal carotid origin via an obluque neck incision.  The carotid artery is then opened and the narrowed segment is "cored" out to leave a healthier lining to the blood vessel.  This is then closed using an artiifical patch to widen the resulting artery.  

The European (ECST) and North American Symptomatic Carotid Endarterectomy (NASCET) trials have demonstrated clear improvement in stroke and death rate in patients with severe symptomatic stenoses. Although asymptomatic carotid stenosis have a lower risk of stroke than those with symptomatic disease, the recent Asymptomatic Carotid Surgery Trial has provided evidence of some advantage with CEA for younger patients with asymptomatic severe disease over 5 years. The complications of CEA are listed below.

COMPLICATIONS AND  MANAGEMENT

 All patients should be aware of possible complications including:

• Stroke in 1-2%
• Mortality in 1%
• Heart problems such as "heart attack" from which you make a good recovery in less than 3% of patients
• Bleeding
• Bruising
• Nerve injury in less than 1% patients
• Wound infection

Discharge

Patients are usually fit for discharge on the 1st or 2nd postoperative day. They should all remain on Aspirin, clopidogrel or Assassantin as directed by the Vascular Surgeon.  

Carotid Stenting

Whilst carotid stenting is less invasive than CEA, it has a higher complication rate than CEA as demonstrated in recent large randomised controlled trials. It still has a role in patients with "hostile" necks such as post-radiotherapy or recurrent carotid narrowings.

 

PRESENTATIONS

Carotid disease