Will the blood supply to the brain be affected during carotid endarterectomy (CEA) repair of the carotid artery? A: For most patients, the brain tissue is able to receive adequate blood supply from other arteries, such as the contralateral carotid artery and the vertebral artery behind it. For a small number of patients, if there is a risk of intraoperative cerebral ischemia, a shunt can be placed through which the blood is temporarily delivered to ensure an adequate blood supply. What is the risk of complications with CEA? A: CEA may also have some surgical complications. Although it may prevent ischemic stroke, it may itself cause ischemic stroke, and other complications include wound hematoma, hypertension, myocardial infarction, cerebral hyperperfusion syndrome, cerebral hemorrhage, and recurrent restenosis. However, most clinical studies confirm that the risk of stroke due to CEA is less than 3%. The ability to achieve a satisfactory outcome from surgery is directly related to the patient’s general condition, neurological function and the surgeon’s experience. Given the risks associated with surgery, it is important to weigh the pros and cons and consider whether a patient is suitable for CEA treatment based on various factors. What anesthesia method is used for CEA at Huashan Hospital of Fudan University for general surgery? A: CEA can be performed under either general or local anesthesia; the advantage of local anesthesia is that the patient is awake, and it is easier to monitor the brain’s response to the temporary blockage of the carotid artery during surgery and decide whether to place a shunt; it can also help to detect surgical complications in a timely manner and take effective measures at an early stage according to the patient’s sensation. General anesthesia, on the other hand, allows timely and accurate control of the patient’s breathing and blood pressure, and also reduces the metabolism of brain tissue and protects the function of brain tissue during ischemia. It should be up to the doctor to decide which anesthesia method is better for each patient on a case-by-case basis. How long does CEA usually take? A: The length of the procedure depends on the complexity of the repair needed and the experience and proficiency of the surgeon, but in general it will be completed in less than two hours. How long is the hospitalization and recovery period? A: This also depends on each patient’s individual case. However, most patients can be discharged from the hospital in 3 or 4 days after surgery. Since the procedure requires only one skin incision for exposure, patients experience only minor discomfort and the recovery period is very short. It is possible to use a patch when repairing an artery, where does it come from and what is it made of? A: In some patients, to prevent restenosis after surgery, a graft may be sutured between the walls of the artery to enlarge the lumen. There are two sources of patches: a venous patch, obtained from another part of the patient’s body such as the internal jugular vein or the saphenous vein in the ankle or groin, or a synthetic material such as polytetrafluoroethylene. Venous patches are generally considered to be more effective. Is angiography still necessary for carotid artery stenosis found on Doppler ultrasonography? A: The ability of ultrasonography to determine the degree of carotid stenosis depends on several factors and is highly dependent on the experience of the ultrasonographer. Most surgeons agree that further definitive testing, such as magnetic resonance angiography, is needed. If this is not conclusive, intra-arterial angiography is required. Is it best to take aspirin or other antiplatelet drugs, which are also effective in preventing stroke, prior to CEA? A: Studies have clearly established that CEA is more effective than optimal drug therapy in patients with severe carotid stenosis. These medications can be administered after surgery. Coronary artery stenosis can be treated with balloon dilation and stenting, can carotid artery stenosis be treated as well? A: Balloon angioplasty and stenting of the carotid arteries is now also performed in many hospitals. For many patients, this is also a safe and effective treatment option.