How is carotid endarterectomy (CEA) performed?
Surgical steps of CEA.
1, Expose the common carotid artery, external carotid artery and internal carotid artery.
2, and temporarily block their blood flow, dissect the common carotid artery and extend the incision to the internal carotid artery. Starting from the common carotid artery, the plaque initiation end is peeled along the circumference of the vessel from the gap between the arterial wall and the plaque, and the lumen is pulled out after transverse cut.
3.Progressively peel distally until the distal end of the plaque in the internal carotid artery, and pull out the plaque gently and carefully with forceps, leaving a smooth and intact inner lumen of the artery
4.Suture the incision.
For most patients, the brain tissue is able to receive an adequate blood supply from other arteries, such as the contralateral carotid artery and the vertebral artery behind. For a small number of patients, if intraoperative cerebral ischemia is a possibility, a shunt can be placed through which blood can be delivered tentatively to ensure adequate blood supply.
What is the risk of complications with CEA?
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 the procedure, it is important to weigh the pros and cons and consider the patient’s suitability for CEA treatment based on a variety of factors.
What type of anesthesia is used for CEA?
CEA can be performed under either general anesthesia or local anesthesia. local anesthesia has the advantage 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 also helps to detect surgical complications in a timely manner and take effective measures early, based on 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. The decision of which anesthesia method is better should be made by the surgeon according to each patient’s specific situation.
How long does CEA usually take?
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?
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 is exposed with only one skin incision, the patient will 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?
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; and a synthetic material such as polytetrafluoroethylene. Venous patches are generally considered to be more effective.
Is angiography still required for carotid stenosis found on Doppler ultrasonography?
The ability of ultrasonography to determine the degree of carotid stenosis depends on several factors and is highly dependent on the experience of the sonographer. Most surgeons agree that further definitive tests, such as magnetic resonance angiography, are needed. If this is not conclusive, intra-arterial angiography is required.
Aspirin or other antiplatelet drugs are also effective in preventing stroke. Is it best to take these drugs prior to CEA?
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?
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. However, their safety and efficacy compared to CEA have not been proven in scientifically rigorous, large-scale clinical trials. Nonetheless, it is possible to perform both methods of treatment on a patient-by-patient basis.