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Atherosclerosis can lead to a build-up of plaque in the carotid artery, causing narrowing and carotid artery disease, which increases the risk for cerebrovascular disease or stroke. Carotid endarterectomy is a surgery performed to remove plaque buildup in the common carotid and internal carotid arteries and improve blood flow. This activity reviews the indications, contraindications, and technique involved in performing a carotid endarterectomy and highlights the role of the interprofessional team in the pre-operative and post-operative care of patients undergoing this procedure. Objectives: Summarize the indications for carotid endarterectomy. Describe the technique involved in performing a carotid endarterectomy. Review the complications associated with carotid endarterectomy. Explain how careful planning and discussion amongst interprofessional team members involved in the management of patients undergoing carotid endarterectomies will improve outcomes. Access free multiple choice questions on this topic.

A build-up of plaque in the carotid artery can lead to atherosclerosis and stenosis of the artery, which may or may not be symptomatic clinically. Such carotid artery disease increases a person’s risk for cerebrovascular disease and stroke. Carotid endarterectomy (CEA) is a surgery performed to decrease the risk of stroke in a patient with known cerebrovascular atherosclerotic disease. The procedure entails removing plaque from the common carotid artery and/or internal carotid artery to improve blood flow and remove potential embolic material, restoring more normal cerebral blood flow. Carotid artery reconstructions began in the early 1950s, and techniques for carotid endarterectomy procedures, as well as indications to perform them, have evolved.[1][2][3][4]

Complications during and after surgery are dependent on various factors, such as surgeon skill and technique, patient’s risk factors, management before or after surgery. Complications of CEA include: Major complications Myocardial Infarction Hyperperfusion syndrome Nerve Injury, particularly the cranial nerves: hypoglossal, vagus, glossopharyngeal, and facial (marginal mandibular) nerves Perioperative stroke Restenosis Death Minor Complications Transient ischemic attack Bleeding Infection Greater auricular nerve injury Dysphagia

Patients with TIA or evidence of carotid artery atherosclerosis are frequently seen by the primary care provider or nurse practitioner. If the workup reveals narrowing of the carotid artery, the patient should be referred to the neurologist and vascular surgeon based on degree of stenosis and symptoms present. Carotid endarterectomy has been shown to reduce the risk of stroke in properly selected patients. Stroke is also a potential complication of CEA, therefore physicians must educate the patient regarding potential complications of the procedure. The primary care physician should encourage the patient to eliminate controllable risk factors for stroke by discontinuing smoking, maintaining a healthy weight and lowering levels of cholesterol. Regular exercise is highly recommended.[14]